Healthcare Provider Details

I. General information

NPI: 1245963198
Provider Name (Legal Business Name): ZOE VAINIKOS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARGER RD STE 820
OAK BROOK IL
60523-1822
US

IV. Provider business mailing address

4520 WOODWARD AVE
DOWNERS GROVE IL
60515-2633
US

V. Phone/Fax

Practice location:
  • Phone: 630-573-7979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019033894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: