Provider Demographics
NPI:1609107929
Name:VINA DENTAL LTD
Entity Type:Organization
Organization Name:VINA DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-692-0900
Mailing Address - Street 1:8118 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2817
Mailing Address - Country:US
Mailing Address - Phone:847-692-0900
Mailing Address - Fax:847-692-0904
Practice Address - Street 1:8118 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2817
Practice Address - Country:US
Practice Address - Phone:847-692-0900
Practice Address - Fax:847-692-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty