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General NPI Number Information
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NPI Number | 1649038142
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Entity Type | Organization
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Legal Business Name | SIMON BOYARSKIY DDS LTD
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 8747 N OKETO AVE
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City | NILES
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State | IL
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Zip | 60714-2068
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Country | US
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Telephone | 847-299-9400
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Fax | 847-795-9291
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Provider Business Mailing Address
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Address Line | 8747 N OKETO AVE
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City | NILES
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State | IL
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Zip | 60714-2068
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Country | US
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Telephone | 847-299-9400
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Fax | 847-795-9291
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Authorized Official
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Title or Position | DOCTOR
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Name | SIMON BOYARSKIY
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Credential | DDS
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Telephone | 847-299-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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