Provider Demographics
NPI:1356464176
Name:DMITRY D. SOKOL, D.D.S., L.T.D.
Entity Type:Organization
Organization Name:DMITRY D. SOKOL, D.D.S., L.T.D.
Other - Org Name:VILLAGE GREEN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-634-3848
Mailing Address - Street 1:185 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3010
Mailing Address - Country:US
Mailing Address - Phone:847-634-3848
Mailing Address - Fax:
Practice Address - Street 1:185 MILWAUKEE AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3010
Practice Address - Country:US
Practice Address - Phone:847-634-3848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty