Provider Demographics
NPI:1518028570
Name:DIMENT, MAINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAINA
Middle Name:
Last Name:DIMENT
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 1:3400 W DUNDEE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-205-0190
Mailing Address - Fax:
Practice Address - Street 1:3400 W DUNDEE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-205-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist