NPI 1003142100

Modern Art of Dentistry, INC

Organisation Dental Clinic/Center Wheeling, IL

Practice location

Address: 75 S Milwaukee Ave, Wheeling, IL 60090-3187
Phone: (847) 465-0800
Fax: (847) 465-0053

Authorised official

Name: Karina Lyon Gavrilov
Title: Owner
Phone: (847) 465-0800

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X Licence 0019-024691 (IL)

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Registry record

NPI: 1003142100
Entity type: Organization
NPI issued: 23 Oct 2009
Record last updated: 23 Oct 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.