Provider Demographics
NPI:1760921019
Name:VL DENTAL CARE TWO
Entity Type:Organization
Organization Name:VL DENTAL CARE TWO
Other - Org Name:ROUTE 14 DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-358-9700
Mailing Address - Street 1:6315 NORTHWEST HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7939
Mailing Address - Country:US
Mailing Address - Phone:815-455-3368
Mailing Address - Fax:815-455-3306
Practice Address - Street 1:6315 NORTHWEST HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7939
Practice Address - Country:US
Practice Address - Phone:815-455-3368
Practice Address - Fax:815-455-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty