Provider Demographics
NPI:1982740973
Name:AYNGORN, IRINA (DDS)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:AYNGORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 LOREL AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:846 N ELMHURST RD
Practice Address - Street 2:PROSPECT HEIGHTS FAMILY DENTAL
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1132
Practice Address - Country:US
Practice Address - Phone:847-229-7988
Practice Address - Fax:847-229-7985
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190247721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice