Organization
DENTAL ON 45 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATALIYA KORNIYCHUK DMD (VICE-PRESIDENT)
(224) 616-9264
Entity
Organization
Contact information
Practice address
34484 N US HIGHWAY 45, SUITE C, THIRD LAKE, IL 60030-4038
(224) 541-4066
(847) 752-8425
Mailing address
34484 N US HIGHWAY 45, SUITE C, THIRD LAKE, IL 60030-4038
(224) 541-4066
(847) 752-8425
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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