MEDICARE: DR. COLIN E O'KASICK DMD

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	019035137	IL

General Provider Information

NPI Number	:	1184466914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN E O'KASICK DMD

Provider Business Mailing Address
First Line	:	2650 BOBWHITE LN
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-5947
Country	:	US
Telephone Number	:	630-441-0941
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 N 4TH ST
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2125
Country	:	US
Telephone Number	:	630-232-4076
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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