Healthcare Provider Details

I. General information

NPI: 1134796402
Provider Name (Legal Business Name): SAMANTHA ZOLTEK-SKIK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA ZOLTEK-SKIK SAMANTHA ZOLTEK-SKIK

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 W ARCHER AVE
CHICAGO IL
60638-2407
US

IV. Provider business mailing address

14509 S HILLCREST RD
HOMER GLEN IL
60491-7540
US

V. Phone/Fax

Practice location:
  • Phone: 773-586-9700
  • Fax:
Mailing address:
  • Phone: 630-995-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.033081
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: