MEDICARE: DR. ALEXANDER OSOVSKY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1174665731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER OSOVSKY DDS

Provider Business Mailing Address
First Line	:	2750 CHARLIE CT
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1000
Country	:	US
Telephone Number	:	847-274-3807
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 MILWAUKEE AVE
Second Line	:	STE 103
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1840
Country	:	US
Telephone Number	:	847-465-9676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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