MEDICARE: D2 DENTAL OF LANSING, 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1235581711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D2 DENTAL OF LANSING, 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	:	2500 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5202
Country	:	US
Telephone Number	:	773-360-1281
Fax Number	:

Authorized Official
Title or Position	:	AGENT
Name	:	MR. BORIS LABINOV
Credential	:
Telephone Number	:	708-386-4100

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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