Provider Demographics
NPI:1801271184
Name:KOROLYOV, JAMIE ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:KOROLYOV
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 1:7702 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4123
Mailing Address - Country:US
Mailing Address - Phone:708-453-7275
Mailing Address - Fax:
Practice Address - Street 1:5912 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3305
Practice Address - Country:US
Practice Address - Phone:773-282-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0302901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice