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NPI Code Detail

MEDICARE: D2 DENTAL OF LANSING, P.C.

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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1891259768
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 STE 310
Second Line :
City : OAK PARK
State : IL
Zip : 60301-1339
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 CHICAGO AVE
Second Line :
City : OAK PARK
State : IL
Zip : 60302-2432
Country : US
Telephone Number : 708-948-7744
Fax Number :
Authorized Official
Title or Position : AGENT
Name : BORIS LABINOV
Credential :
Telephone Number : 312-404-3975
Provider Enumeration Date : 01/24/2019
Last Update Date : 01/24/2019

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