Provider Demographics
NPI:1932533817
Name:NATALIYA KORNIYCHUK DMD LTD
Entity Type:Organization
Organization Name:NATALIYA KORNIYCHUK DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNIYCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-616-9264
Mailing Address - Street 1:1002 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-3211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34484 N US HIGHWAY 45
Practice Address - Street 2:SUITE C
Practice Address - City:THIRD LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-4038
Practice Address - Country:US
Practice Address - Phone:224-541-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028386261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental