# JOHN J DZAKOVICH DDS LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maywood Family Dental ltd
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245634534
- **Authorized official:** DR. JAMES POULOS DDS (PRESIDENT)
- **Authorized official phone:** (708) 865-2225

## Contact information

- **Practice address:** 1409 S 5TH AVE, MAYWOOD, IL 60153-2128
- **Practice address phone:** (708) 865-2225
- **Mailing address:** 1409 S 5TH AVE, MAYWOOD, IL 60153-2128
- **Mailing address phone:** (708) 865-2225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 019.016695 | IL | Yes |

## Other

- **Enumeration date:** 10/15/2014
- **Last updated:** 10/15/2014