Provider Demographics
NPI:1689789596
Name:FERDKOFF, VLAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:VLAD
Middle Name:
Last Name:FERDKOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 S GROVE AVE # S.106
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5211
Mailing Address - Country:US
Mailing Address - Phone:847-842-2410
Mailing Address - Fax:847-842-0564
Practice Address - Street 1:1531 S GROVE AVE # S.106
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5211
Practice Address - Country:US
Practice Address - Phone:847-842-2410
Practice Address - Fax:847-842-0564
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist