Provider Demographics
NPI:1982123030
Name:KUSHNIR, VIKTORIYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIKTORIYA
Middle Name:
Last Name:KUSHNIR
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 1:1297 GEORGETOWN WAY
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4125
Mailing Address - Country:US
Mailing Address - Phone:224-203-1215
Mailing Address - Fax:
Practice Address - Street 1:1297 GEORGETOWN WAY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4125
Practice Address - Country:US
Practice Address - Phone:224-203-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190312411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty