Provider Demographics
NPI:1093183907
Name:KRATUNOVA, EVELINA (BDS, MDS, DCHDENT)
Entity type:Individual
Prefix:DR
First Name:EVELINA
Middle Name:
Last Name:KRATUNOVA
Suffix:
Gender:F
Credentials:BDS, MDS, DCHDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S PAULINA ST # MC850
Mailing Address - Street 2:ROOM 269-C PEDIATRIC DENTISTRY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:312-996-1984
Mailing Address - Fax:312-413-1638
Practice Address - Street 1:801 S PAULINA ST # MC850
Practice Address - Street 2:ROOM 269-C PEDIATRIC DENTISTRY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-996-1984
Practice Address - Fax:312-413-1638
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1360002001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry