Provider Demographics
NPI:1134796402
Name:ZOLTEK-SKIK, SAMANTHA (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:ZOLTEK-SKIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:ZOLTEK-SKIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAMANTHA ZOLTEK-SKIK
Mailing Address - Street 1:14509 S HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7540
Mailing Address - Country:US
Mailing Address - Phone:630-995-5882
Mailing Address - Fax:
Practice Address - Street 1:6615 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2407
Practice Address - Country:US
Practice Address - Phone:773-586-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist