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General NPI Number Information
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NPI Number | 1558177238
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Entity Type | Organization
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Legal Business Name | VASTLIK, LTD
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 101 S OAK PARK AVE
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City | OAK PARK
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State | IL
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Zip | 60302-2901
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Country | US
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Telephone | 708-386-0960
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 N LEAVITT ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60647-3246
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Country | US
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Telephone | 815-992-8393
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Fax |
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. BRENDAN THOMAS VASTLIK
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Credential | DDS
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Telephone | 815-992-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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