Individual
DR. MARIYA IVANOVA MANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2746 W FULLERTON AVE, CHICAGO, IL 60647-3059
(501) 773-1233
Mailing address
502 MAPLE LN, DARIEN, IL 60561-4067
(501) 773-1233
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027529
IL
Other
Enumeration date
11/17/2007
Last updated
12/23/2012
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