Provider Demographics
NPI:1760794119
Name:KORNIYCHUK, NATALIYA (DMD)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:KORNIYCHUK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-3211
Mailing Address - Country:US
Mailing Address - Phone:224-616-9264
Mailing Address - Fax:
Practice Address - Street 1:34484 N US HIGHWAY 45 STE C
Practice Address - Street 2:
Practice Address - City:THIRD LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-4038
Practice Address - Country:US
Practice Address - Phone:224-541-4066
Practice Address - Fax:847-752-8425
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0283861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice