Chicago Mall Dental Associates, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CHICAGO MALL DENTAL ASSOCIATES, LLC

Doing business as

Lincolnwood Mall Dental

Practice address

3333 W Touhy Ave Unit G01
Lincolnwood, IL 60712-2753

Phone

(847) 807-7601

NPI assigned

Oct 13, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rostislav Krasnov

Title

Owner

Phone

(786) 475-7600

Specialties & licenses 1

Addresses

Other names 1

• Lincolnwood Mall Dental Doing business as

Tax ID family

Chicago Mall Dental Associates LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Chicago Mall Dental Associates, LLC

  dba North Riverside Mall Dental

  • Dentist
  • North Riverside, IL
  • NPI 1245741578
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1700397031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 W TOUHY AVE UNIT G01",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607122753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 W TOUHY AVE UNIT G01",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607122753",
            "telephone_number": "847-807-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO MALL DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-475-7600"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincolnwood Mall Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Svetlana Cherny, M.D.
• Chicago Associates in Counseling and Psychotherapy, LTD. (A Positive Therapy Center)
• Chicago Center for Healthy Minds, PLLC
• Chicago Center for Torah & Chesed Inc. (The Chicago Center)
• Chicago Hearing LLC (Miracle Ear)
• Chicago Mall Dental, LLC (Lincolnwood Mall Dental)
• Chicago Pain and Rehabilitation Clinic P.C. (Chicago Pain and Rehabilitation Center)
• Emma Claire Childers
• Hillary Childs
• Cara Chill

• Dentist in Lincolnwood, IL
• Providers in Lincolnwood, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.