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NPI Code Detail

MEDICARE: GENRIKH GANDELSMAN DDS MSD LTD

MEDICARE: GENRIKH GANDELSMAN DDS MSD LTD
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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryIL

General Provider Information

NPI Number : 1356496350
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENRIKH GANDELSMAN DDS MSD LTD
Provider Business Mailing Address
First Line : 3065 FALLING WATERS BLVD
Second Line :
City : LINDENHURST
State : IL
Zip : 60046-6793
Country : US
Telephone Number : 224-643-4381
Fax Number :
Provider Business Practice Location Address
First Line : 3065 FALLING WATERS BLVD
Second Line :
City : LINDENHURST
State : IL
Zip : 60046-6793
Country : US
Telephone Number : 224-643-4381
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. GENRIKH GANDELSMAN
Credential : DDS
Telephone Number : 224-643-4381
Provider Enumeration Date : 01/23/2007
Last Update Date : 08/14/2013

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Practice Location Address:
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