Healthcare Provider Details

I. General information

NPI: 1194137208
Provider Name (Legal Business Name): D2 DENTAL AT OAK STREET, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 W IRVING PARK RD
CHICAGO IL
60641-2718
US

IV. Provider business mailing address

137 N OAK PARK AVE SUITE 310
OAK PARK IL
60301-1344
US

V. Phone/Fax

Practice location:
  • Phone: 773-724-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BORIS LABINOV
Title or Position: AGENT
Credential:
Phone: 708-445-2668