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General NPI Number Information
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NPI Number | 1285788133
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Entity Type | Organization
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Legal Business Name | LARISA FELDMAN, DDS, PC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 307 W DUNDEE RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-3545
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Country | US
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Telephone | 847-638-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 648 LONG COVE CT
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City | RIVERWOODS
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State | IL
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Zip | 60015-3850
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Country | US
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Telephone | 847-638-6060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARISA FELDMAN
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Credential | DDA
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Telephone | 847-638-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019-025103
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License Number State | IL
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