Provider Demographics
NPI:1982795324
Name:BANAKIS, MARK L (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:BANAKIS
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 1:21813 TALL OAK
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-540-1224
Mailing Address - Fax:
Practice Address - Street 1:999 N PLAZA DR STE 102
Practice Address - Street 2:SUITE 2N
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5403
Practice Address - Country:US
Practice Address - Phone:847-882-9448
Practice Address - Fax:847-882-9496
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210016111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U36156Medicare UPIN