Organization
CHICAGO MALL DENTAL, LLC
Active
Other names
Lincolnwood Mall Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSTISLAV KRASNOV DDS (PRESIDENT)
(786) 475-7600
Entity
Organization
Contact information
Practice address
3333 W TOUHY AVE, LINCOLNWOOD, IL 60712-2721
(917) 902-9515
Mailing address
3333 W TOUHY AVE, LINCOLNWOOD, IL 60712-2721
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028976
IL
Other
Enumeration date
08/24/2015
Last updated
08/24/2015
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