Irina Bolotnikov DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029871 Issued in IL

Legal business name

IRINA BOLOTNIKOV DDS PC

Practice address

7963 Gold Road
Morton Grove, IL 60053

Phone

(847) 583-0033

Fax

(847) 583-0013

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Irina Bolotnikov, DDS

Title

Dentist President

Phone

(847) 583-0033

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1740326313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7963 GOLD ROAD",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "60053",
            "telephone_number": "847-583-0033",
            "fax_number": "847-583-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7963 GOLD ROAD",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "60053",
            "telephone_number": "847-583-0033",
            "fax_number": "847-583-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRINA BOLOTNIKOV DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "BOLOTNIKOV",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "DENTIST PRESIDENT",
        "authorized_official_telephone_number": "847-583-0033",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.