Provider Demographics
NPI:1336495266
Name:TATIANA OSTANINA DDS, LTD
Entity Type:Organization
Organization Name:TATIANA OSTANINA DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTANINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-453-8400
Mailing Address - Street 1:7730 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4124
Mailing Address - Country:US
Mailing Address - Phone:708-453-8400
Mailing Address - Fax:708-453-8440
Practice Address - Street 1:7730 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4124
Practice Address - Country:US
Practice Address - Phone:708-453-8400
Practice Address - Fax:708-453-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025354261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental