Healthcare Provider Details

I. General information

NPI: 1467574269
Provider Name (Legal Business Name): SCOTT R MUSIL DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 S OAK PARK AVE
STICKNEY IL
60402-4169
US

IV. Provider business mailing address

3905 S OAK PARK AVE
STICKNEY IL
60402-4169
US

V. Phone/Fax

Practice location:
  • Phone: 708-749-2040
  • Fax: 708-749-9843
Mailing address:
  • Phone: 708-749-2040
  • Fax: 708-749-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SCOTT ROBERT MUSIL
Title or Position: OWNER
Credential: DDS
Phone: 708-749-2040