Provider Demographics
NPI:1972241438
Name:KONSTANTINOVSKY, VICTOR SHELDON (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:SHELDON
Last Name:KONSTANTINOVSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W SURF ST APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6040
Mailing Address - Country:US
Mailing Address - Phone:917-757-2095
Mailing Address - Fax:
Practice Address - Street 1:7064 W BELMONT AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4592
Practice Address - Country:US
Practice Address - Phone:773-840-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0336011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice