Organization
CHICAGO MALL DENTAL ASSOCIATES, LLC
Active
Other names
North Riverside Mall Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV (OWNER)
(786) 475-7600
Entity
Organization
Contact information
Practice address
7501 W CERMAK RD STE F16, NORTH RIVERSIDE, IL 60546-2815
(708) 402-8001
Mailing address
7501 W CERMAK RD STE F16, NORTH RIVERSIDE, IL 60546-2815
(708) 402-8001
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
10/13/2017
Last updated
10/13/2017
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