Provider Demographics
NPI:1588755888
Name:DUBOVIK-BATTISTO, KIM S (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:S
Last Name:DUBOVIK-BATTISTO
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 1:141 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1774
Mailing Address - Country:US
Mailing Address - Phone:630-221-8501
Mailing Address - Fax:
Practice Address - Street 1:141 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1774
Practice Address - Country:US
Practice Address - Phone:630-221-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190230601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363869444OtherTIN