Provider Demographics
NPI:1225111529
Name:MOROZOVA, NELLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NELLI
Middle Name:
Last Name:MOROZOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N CLARK ST
Mailing Address - Street 2:STE 600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:312-274-4526
Mailing Address - Fax:212-751-0556
Practice Address - Street 1:350 N CLARK ST
Practice Address - Street 2:STE 600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4712
Practice Address - Country:US
Practice Address - Phone:312-274-4526
Practice Address - Fax:212-751-0556
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist