Organization
VITAL DENTAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WASAN BALOCH DMD (OWNER)
(708) 529-0900
Entity
Organization
Contact information
Practice address
2835 W 95TH ST, EVERGREEN PARK, IL 60805-2702
(630) 915-7863
Mailing address
8908 MIDDLETON RD, DARIEN, IL 60561-8441
(630) 915-7863
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019030247
—
IL
Enumeration date
01/14/2019
Last updated
09/17/2020
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