| Vital Dental Care Inc | |
|
2835 W 95th St Evergreen Park IL 60805-2702 | |
| (630) 915-7863 | |
| Not Available |
| Full Name | Vital Dental Care Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2835 W 95th St, Evergreen Park, Illinois |
| Authorized Official Name and Position | Wasan Baloch (OWNER) |
| Authorized Official Contact | 7085290900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Dental Care Inc 8908 Middleton Rd Darien IL 60561-8441 Ph: (630) 915-7863 | Vital Dental Care Inc 2835 W 95th St Evergreen Park IL 60805-2702 Ph: (630) 915-7863 |
| NPI Number | 1316411234 |
|---|---|
| Provider Enumeration Date | 01/14/2019 |
| Last Update Date | 09/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316411234 | NPI | - | NPPES |
| 019030247 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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