Provider Demographics
NPI:1912092362
Name:MAKOWSKI, JOSEPH RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:MAKOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2028
Mailing Address - Country:US
Mailing Address - Phone:708-366-2815
Mailing Address - Fax:
Practice Address - Street 1:6801 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2009
Practice Address - Country:US
Practice Address - Phone:773-763-8490
Practice Address - Fax:773-763-8534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice