Provider Demographics
NPI:1447362678
Name:BOYARSKIY, SIMON (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:BOYARSKIY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GOLF MILL CTR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1224
Mailing Address - Country:US
Mailing Address - Phone:847-299-9400
Mailing Address - Fax:847-795-9291
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 502
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-299-9400
Practice Address - Fax:847-795-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021001943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist