Chicago Mall Dental, LLC

NPI #1235507583 in North Riverside, Illinois

Provider Information

NPI Number: 1235507583
Entity Type: Organization
Organization Name: Chicago Mall Dental, LLC
Primary Specialty: Dentist
Enumeration Date: Sep 3, 2015
Last Updated: Sep 3, 2015

Practice Location

Address: 7501 W CERMAK RD
City: North Riverside
State: Illinois
ZIP Code: 60546-1438
Phone: (917) 902-9515

Authorized Official

Name: DR. ROSTISLAV KRASNOV, DDS
Title: PRESIDENT
Phone: (917) 902-9515

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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