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General NPI Number Information
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NPI Number | 1205735982
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Entity Type | Organization
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Legal Business Name | POLINA GUBAREVA DMD PLLC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 5613 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-2740
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Country | US
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Telephone | 847-840-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 7750 N OCTAVIA AVE
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City | NILES
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State | IL
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Zip | 60714-4751
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Country | US
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Telephone | 847-840-8301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. POLINA GUBAREVA
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Credential | DMD
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Telephone | 847-840-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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