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NPI Code Detail

MEDICARE: D2 DENTAL AT OAK STREET, P.C.

MEDICARE: D2 DENTAL AT OAK STREET, P.C.
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1194137208
Entity Type Code : Organization
Provider Name (Legal Business Name) : D2 DENTAL AT OAK STREET, P.C.
Provider Business Mailing Address
First Line : 137 N OAK PARK AVE
Second Line : SUITE 310
City : OAK PARK
State : IL
Zip : 60301-1344
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4848 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60641-2718
Country : US
Telephone Number : 773-724-6200
Fax Number :
Authorized Official
Title or Position : AGENT
Name : BORIS LABINOV
Credential :
Telephone Number : 708-445-2668
Provider Enumeration Date : 05/22/2014
Last Update Date : 05/22/2014

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