Provider Demographics
NPI:1932470739
Name:VICARI, JENISE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENISE
Middle Name:J
Last Name:VICARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 WAUKEGAN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3065
Mailing Address - Country:US
Mailing Address - Phone:847-998-6684
Mailing Address - Fax:
Practice Address - Street 1:1132 WAUKEGAN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3065
Practice Address - Country:US
Practice Address - Phone:847-998-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist