| Lincolnwood Mall Dental | |
|
3333 W Touhy Ave Unit G01 Lincolnwood IL 60712-2753 | |
| (847) 807-7601 | |
| Not Available |
| Full Name | Lincolnwood Mall Dental |
|---|---|
| Speciality | Dentist |
| Location | 3333 W Touhy Ave Unit G01, Lincolnwood, Illinois |
| Authorized Official Name and Position | Rostislav Krasnov (OWNER) |
| Authorized Official Contact | 7864757600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lincolnwood Mall Dental 3333 W Touhy Ave Unit G01 Lincolnwood IL 60712-2753 Ph: () - | Lincolnwood Mall Dental 3333 W Touhy Ave Unit G01 Lincolnwood IL 60712-2753 Ph: (847) 807-7601 |
| NPI Number | 1700397031 |
|---|---|
| Provider Enumeration Date | 10/13/2017 |
| Last Update Date | 10/13/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700397031 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Illinois) | Primary |
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