Provider Demographics
NPI:1366699142
Name:JOHN A. MARSALA D.D.S. ; LTD
Entity type:Organization
Organization Name:JOHN A. MARSALA D.D.S. ; LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-310-4897
Mailing Address - Street 1:8225 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1517
Mailing Address - Country:US
Mailing Address - Phone:630-310-4897
Mailing Address - Fax:
Practice Address - Street 1:8225 GRAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1517
Practice Address - Country:US
Practice Address - Phone:630-310-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-187241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty