Provider Demographics
NPI:1750656690
Name:D2 DENTAL OF HAMMOND
Entity Type:Organization
Organization Name:D2 DENTAL OF HAMMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LABINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-386-4100
Mailing Address - Street 1:137 N OAK PARK AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1738 165TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2821
Practice Address - Country:US
Practice Address - Phone:708-386-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-10
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty