MEDICARE: DR. ROBERT J VAVRIK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19-17681	IL

General Provider Information

NPI Number	:	1770791766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J VAVRIK DDS

Provider Business Mailing Address
First Line	:	2302 E RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5182
Country	:	US
Telephone Number	:	847-670-0700
Fax Number	:	847-670-0720

Provider Business Practice Location Address
First Line	:	2302 E RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5182
Country	:	US
Telephone Number	:	847-670-0700
Fax Number	:	847-670-0720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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