Provider Demographics
NPI:1700079720
Name:NAYDENOFF, CARRIE LYNN (RDH)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:LYNN
Last Name:NAYDENOFF
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E 22ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4976
Mailing Address - Country:US
Mailing Address - Phone:630-627-4680
Mailing Address - Fax:
Practice Address - Street 1:2 E 22ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4976
Practice Address - Country:US
Practice Address - Phone:630-627-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20012118124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist