Provider Demographics
NPI:1679740534
Name:IZVANARIU, CONSTANTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTIN
Middle Name:
Last Name:IZVANARIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3377
Mailing Address - Country:US
Mailing Address - Phone:847-677-5150
Mailing Address - Fax:847-677-5307
Practice Address - Street 1:7514 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3377
Practice Address - Country:US
Practice Address - Phone:847-677-5150
Practice Address - Fax:847-677-5307
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0182791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice