MEDICARE: OS DENTAL LOUNGE

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	122300000X	Dentist	019.027079	IL

General Provider Information

NPI Number	:	1356736748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OS DENTAL LOUNGE

Provider Business Mailing Address
First Line	:	5120 W IRVING PARK RD UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2624
Country	:	US
Telephone Number	:	314-753-6005
Fax Number	:

Provider Business Practice Location Address
First Line	:	5120 W IRVING PARK RD UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2624
Country	:	US
Telephone Number	:	314-753-6005
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LYUDMILA TAVOLZHANSKAYA
Credential	:	DDS
Telephone Number	:	314-753-6005

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	04/02/2015

Similar Medicare Providers

1295914497 — EQUINOX HEALTH CENTER
Practice Location Address:

5122 W IRVING PARK RD
CHICAGO, IL
60641-2624

Practice Phone: 773-282-7952
Practice Fax:

1710161625 — PAWEL SARATA MD SC
Practice Location Address:

5122 W IRVING PARK RD
CHICAGO, IL
60641-2624

Practice Phone: 773-282-7952
Practice Fax: 773-282-6158

1053490219 — MARCIA ELLEN BLAKE O.D.
Practice Location Address:

1903 W 103RD ST
CHICAGO, IL
60643-2624

Practice Phone: 773-233-7799
Practice Fax:

1073779401 — JON ZIMMERMAN OTR/L
Practice Location Address:

2624 W BIRCHWOOD AVE
CHICAGO, IL
60645-1404

Practice Phone: 773-262-9661
Practice Fax:

1801171277 — MED STAFF ON-CALL
Practice Location Address:

1332 N HALSTED ST , SUITE 301
CHICAGO, IL
60642-2624

Practice Phone: 888-270-8374
Practice Fax: 888-288-7102

1205253200 — MARCIA E. BLAKE, O.D.
Practice Location Address:

1903 W 103RD ST
CHICAGO, IL
60643-2624

Practice Phone: 773-233-7799
Practice Fax: 773-233-6362

Directions to “OS DENTAL LOUNGE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.