Healthcare Provider Details

I. General information

NPI: 1700439262
Provider Name (Legal Business Name): EV DENTAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N SEYMOUR AVE
MUNDELEIN IL
60060-2305
US

IV. Provider business mailing address

323 N SEYMOUR AVE
MUNDELEIN IL
60060-2305
US

V. Phone/Fax

Practice location:
  • Phone: 847-566-7522
  • Fax: 847-566-7531
Mailing address:
  • Phone: 847-566-7522
  • Fax: 847-566-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDUARD VERNOVSKY
Title or Position: PRESIDENT
Credential: DDS
Phone: 224-392-9450