Provider Demographics
NPI:1710012976
Name:MALIN BOTVINNIK DDS PC
Entity Type:Organization
Organization Name:MALIN BOTVINNIK DDS PC
Other - Org Name:SMILING PATIENT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-824-5151
Mailing Address - Street 1:322 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2735
Mailing Address - Country:US
Mailing Address - Phone:847-824-5151
Mailing Address - Fax:
Practice Address - Street 1:322 N WOLF RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2735
Practice Address - Country:US
Practice Address - Phone:847-824-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190250721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty