Provider Demographics
NPI:1447347125
Name:PAUL MACO, D.D.S., P.C.
Entity type:Organization
Organization Name:PAUL MACO, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-513-6760
Mailing Address - Street 1:202 S. KIRK RD.
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2429
Mailing Address - Country:US
Mailing Address - Phone:630-513-6760
Mailing Address - Fax:630-513-7137
Practice Address - Street 1:202 S. KIRK RD.
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2429
Practice Address - Country:US
Practice Address - Phone:630-513-6760
Practice Address - Fax:630-513-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600093651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty