Provider Demographics
NPI:1033695309
Name:BK DENTAL-EVANSTON LLC
Entity Type:Organization
Organization Name:BK DENTAL-EVANSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORISLAV
Authorized Official - Middle Name:DENKOV
Authorized Official - Last Name:KALTCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-343-0415
Mailing Address - Street 1:259 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3216
Mailing Address - Country:US
Mailing Address - Phone:312-343-0415
Mailing Address - Fax:630-766-2537
Practice Address - Street 1:636 CHURCH ST STE 304
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4579
Practice Address - Country:US
Practice Address - Phone:312-343-0415
Practice Address - Fax:630-766-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental