Provider Demographics
NPI:1447270236
Name:RAYMOND J. MATEJCAK, D.D.S., LTD.
Entity type:Organization
Organization Name:RAYMOND J. MATEJCAK, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MATEJCAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-742-1330
Mailing Address - Street 1:2000 LARKIN AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4404
Mailing Address - Country:US
Mailing Address - Phone:847-742-1330
Mailing Address - Fax:847-742-1016
Practice Address - Street 1:2000 LARKIN AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4404
Practice Address - Country:US
Practice Address - Phone:847-742-1330
Practice Address - Fax:847-742-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty