Healthcare Provider Details

I. General information

NPI: 1447429394
Provider Name (Legal Business Name): LISA VIHNANEK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 W 35TH ST
CICERO IL
60804-4163
US

IV. Provider business mailing address

5907 W 35TH ST
CICERO IL
60804-4163
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-2441
  • Fax: 708-656-2515
Mailing address:
  • Phone: 708-656-2441
  • Fax: 708-656-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: