MEDICARE: VINA DENTAL LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019026568	IL

General Provider Information

NPI Number	:	1609107929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINA DENTAL LTD

Provider Business Mailing Address
First Line	:	8118 N MILWAUKEE AVE
Second Line	:	SUITE 100
City	:	NILES
State	:	IL
Zip	:	60714-2817
Country	:	US
Telephone Number	:	847-692-0900
Fax Number	:	847-692-0904

Provider Business Practice Location Address
First Line	:	8118 N MILWAUKEE AVE
Second Line	:	SUITE 100
City	:	NILES
State	:	IL
Zip	:	60714-2817
Country	:	US
Telephone Number	:	847-692-0900
Fax Number	:	847-692-0904

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. NADIA ODISH
Credential	:	DDS
Telephone Number	:	847-692-0900

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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