Organization
CHICAGO MALL DENTAL ASSOCIATES, LLC
Active
Other names
Lincolnwood Mall Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV KRASNOV (OWNER)
(786) 475-7600
Entity
Organization
Contact information
Practice address
3333 W TOUHY AVE UNIT G01, LINCOLNWOOD, IL 60712-2753
(847) 807-7601
Mailing address
3333 W TOUHY AVE UNIT G01, LINCOLNWOOD, IL 60712-2753
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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