Provider Demographics
NPI:1205082302
Name:MAGDALINA NIKOLOV DDS
Entity type:Organization
Organization Name:MAGDALINA NIKOLOV DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALINA
Authorized Official - Middle Name:BORISSOVA
Authorized Official - Last Name:NIKOLOV
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-657-8818
Mailing Address - Street 1:2604 PATRIOT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:847-657-8818
Mailing Address - Fax:847-657-8858
Practice Address - Street 1:2604 PATRIOT BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8024
Practice Address - Country:US
Practice Address - Phone:847-657-8818
Practice Address - Fax:847-657-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0262031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9199867Medicaid