Healthcare Provider Details

I. General information

NPI: 1154872174
Provider Name (Legal Business Name): YEVGEN TKACHUK DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E DUNDEE RD
BUFFALO GROVE IL
60089-4383
US

IV. Provider business mailing address

4238 N BLOOMINGTON AVE 203
ARLINGTON HEIGHTS IL
60004-8310
US

V. Phone/Fax

Practice location:
  • Phone: 847-229-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019029513
License Number StateIL

VIII. Authorized Official

Name: DR. YEVGEN TKACHUK
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 312-544-9384