Organization
VIDEKA DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS ANTHONY VIDEKA D.D.S. (CEO)
(708) 798-0444
Entity
Organization
Contact information
Practice address
1924 HICKORY RD, HOMEWOOD, IL 60430-2239
(708) 798-0444
(708) 798-3358
Mailing address
1924 HICKORY RD, HOMEWOOD, IL 60430-2239
(708) 798-0444
(708) 798-3358
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019018734
IL
Other
Enumeration date
03/01/2010
Last updated
03/01/2010
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