Organization
IRINA BOLOTNIKOV DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRINA BOLOTNIKOV DDS (DENTIST PRESIDENT)
(847) 583-0033
Entity
Organization
Contact information
Practice address
7963 GOLD ROAD, MORTON GROVE, IL 60053
(847) 583-0033
(847) 583-0013
Mailing address
7963 GOLD ROAD, MORTON GROVE, IL 60053
(847) 583-0033
(847) 583-0013
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019029871
IL
Other
Enumeration date
01/30/2007
Last updated
06/18/2008
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