Provider Demographics
NPI:1497827059
Name:HOLLYWOOD SMILE LTD
Entity Type:Organization
Organization Name:HOLLYWOOD SMILE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:YARIGINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-679-9122
Mailing Address - Street 1:PO BOX 46261
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-0261
Mailing Address - Country:US
Mailing Address - Phone:847-679-9122
Mailing Address - Fax:
Practice Address - Street 1:6439 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3407
Practice Address - Country:US
Practice Address - Phone:847-679-9122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty