Provider Demographics
NPI:1437046224
Name:MARKO, THEODHOR (DMD)
Entity type:Individual
Prefix:
First Name:THEODHOR
Middle Name:
Last Name:MARKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4354
Mailing Address - Country:US
Mailing Address - Phone:630-995-6280
Mailing Address - Fax:
Practice Address - Street 1:2964 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5409
Practice Address - Country:US
Practice Address - Phone:815-363-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0361741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice