MEDICARE: MISS KARA L OPHEIM 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	122300000X	Dentist	019.030570	IL

General Provider Information

NPI Number	:	1306257134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KARA L OPHEIM DDS

Provider Business Mailing Address
First Line	:	1835 BROADWAY ST
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-2040
Country	:	US
Telephone Number	:	708-548-3727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4077
Country	:	US
Telephone Number	:	503-588-6960
Fax Number	:

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

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	10/03/2024

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Directions to “ MISS KARA L OPHEIM DDS” Practice Location

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