Provider Demographics
NPI:1881764264
Name:DONNA MADDALOZZO DDS MS PC
Entity type:Organization
Organization Name:DONNA MADDALOZZO DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:847-934-4280
Mailing Address - Street 1:649 N FIRST BANK DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8111
Mailing Address - Country:US
Mailing Address - Phone:847-934-4280
Mailing Address - Fax:847-934-4294
Practice Address - Street 1:649 N FIRST BANK DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8111
Practice Address - Country:US
Practice Address - Phone:847-934-4280
Practice Address - Fax:847-934-4294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty