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General NPI Number Information
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NPI Number | 1326210998
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Entity Type | Organization
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Legal Business Name | YELENA M REVICH DDS LTD
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 1455 E GOLF RD # 209
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City | DES PLAINES
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State | IL
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Zip | 60016-1250
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Country | US
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Telephone | 847-296-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 E GOLF RD # 209
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City | DES PLAINES
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State | IL
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Zip | 60016-1250
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Country | US
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Telephone | 847-296-3733
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YELENA M REVICH
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Credential | DDS
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Telephone | 847-494-5819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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