Provider Demographics
NPI:1558556456
Name:SHEILA M. VACENDAK, DDS, PC
Entity type:Organization
Organization Name:SHEILA M. VACENDAK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VACENDAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-402-6231
Mailing Address - Street 1:340 E RANDOLPH ST STE 1304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7314
Mailing Address - Country:US
Mailing Address - Phone:312-402-6231
Mailing Address - Fax:
Practice Address - Street 1:6056 159TH ST
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2904
Practice Address - Country:US
Practice Address - Phone:708-687-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty