Provider Demographics
NPI:1396942579
Name:NEDVETSKY, YANA (DDS)
Entity type:Individual
Prefix:DR
First Name:YANA
Middle Name:
Last Name:NEDVETSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE.
Mailing Address - Street 2:SUITE 622
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3821
Mailing Address - Country:US
Mailing Address - Phone:312-236-8065
Mailing Address - Fax:312-236-7090
Practice Address - Street 1:30 N MICHIGAN AVE.
Practice Address - Street 2:SUITE 622
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3821
Practice Address - Country:US
Practice Address - Phone:312-236-8065
Practice Address - Fax:312-236-7090
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist