Chicago Mall Dental Associates, LLC

NPI #1245741578 in North Riverside, Illinois

Provider Information

NPI Number: 1245741578
Entity Type: Organization
Organization Name: Chicago Mall Dental Associates, LLC
Primary Specialty: Dentist
Enumeration Date: Oct 13, 2017
Last Updated: Oct 13, 2017

Practice Location

Address: 7501 W CERMAK RD STE F16
City: North Riverside
State: Illinois
ZIP Code: 60546-2815
Phone: (708) 402-8001

Authorized Official

Name: ROSTISLAV KRASNOV
Title: OWNER
Phone: (786) 475-7600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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