Healthcare Provider Details

I. General information

NPI: 1467527788
Provider Name (Legal Business Name): JOHN ALLAN VRAVICK DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PHILLIP ROAD SUITE 112
VERNON HILLS IL
60061-1730
US

IV. Provider business mailing address

10 PHILLIP ROAD SUITE 112
VERNON HILLS IL
60061-1730
US

V. Phone/Fax

Practice location:
  • Phone: 847-680-6900
  • Fax: 847-680-6905
Mailing address:
  • Phone: 847-680-6900
  • Fax: 847-680-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6313
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021001515
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: