Provider Demographics
NPI:1497083034
Name:DENTAL VUE PC
Entity Type:Organization
Organization Name:DENTAL VUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ICHKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-414-3573
Mailing Address - Street 1:1447 LEE ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1516
Mailing Address - Country:US
Mailing Address - Phone:847-414-3573
Mailing Address - Fax:
Practice Address - Street 1:1447 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1516
Practice Address - Country:US
Practice Address - Phone:847-414-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060010238261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental