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General NPI Number Information
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NPI Number | 1073918629
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Entity Type | Organization
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Legal Business Name | NATALYA NAGORNAYA DDS PC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 472 HALF DAY RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089
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Country | US
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Telephone | 847-634-2525
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Fax | 847-634-2860
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Provider Business Mailing Address
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Address Line | 472 HALF DAY RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089
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Country | US
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Telephone | 847-634-2525
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Fax | 847-634-2860
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATALYA NAGORNAYA
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Credential |
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Telephone | 847-634-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.025691
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License Number State | IL
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