Provider Demographics
NPI:1376589424
Name:SCOTT D VLK DDS PC
Entity Type:Organization
Organization Name:SCOTT D VLK DDS PC
Other - Org Name:PRAIRIE GARDEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:VLK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-553-6565
Mailing Address - Street 1:200 GARDEN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560
Mailing Address - Country:US
Mailing Address - Phone:630-553-6565
Mailing Address - Fax:630-553-2986
Practice Address - Street 1:200 GARDEN ST
Practice Address - Street 2:SUITE C
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-553-6565
Practice Address - Fax:630-553-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty