Provider Demographics
NPI:1831247550
Name:NIKOLOV, MAGDALINA BORISSOVA (DDS)
Entity type:Individual
Prefix:
First Name:MAGDALINA
Middle Name:BORISSOVA
Last Name:NIKOLOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MAGDALINA
Other - Middle Name:BORISSOVA
Other - Last Name:ARGIROVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2604 PATRIOT BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:708-334-9968
Mailing Address - Fax:847-657-8818
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:847-657-8858
Practice Address - Fax:847-657-8858
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9199867Medicaid