Organization
D2 DENTAL OF HAMMOND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BORIS LABINOV (AGENT)
(708) 386-4100
Entity
Organization
Contact information
Practice address
1738 165TH ST, SUITE 300, HAMMOND, IN 46320-2821
(708) 386-4100
Mailing address
137 N OAK PARK AVE, SUITE 302A, OAK PARK, IL 60301-1344
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/10/2012
Last updated
11/15/2013
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