Organization
LAKESIDE DENTAL CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN KOZLOV D.D.S (OWNER)
(312) 842-7133
Entity
Organization
Contact information
Practice address
2218 S MICHIGAN AVE, CHICAGO, IL 60616-2126
(312) 842-7133
(312) 842-2214
Mailing address
2218 S MICHIGAN AVE, CHICAGO, IL 60616-2126
(312) 842-7133
(312) 842-2214
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019010535
IL
Other
Enumeration date
09/07/2011
Last updated
09/07/2011
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