Individual
ALIAKSANDR SHABANOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5200 S ARCHER AVE, CHICAGO, IL 60632-4772
(773) 581-1345
Mailing address
1416 W CULLERTON ST APT 2R, CHICAGO, IL 60608-3017
(347) 981-0552
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.031814
IL
Other
Enumeration date
08/02/2018
Last updated
08/02/2018
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