MEDICARE: O SEMENY DDS LTD

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	019026015	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780122465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O SEMENY DDS LTD

Provider Business Mailing Address
First Line	:	5 E CAMP MCDONALD RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1527
Country	:	US
Telephone Number	:	847-818-9250
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 E CAMP MCDONALD RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1527
Country	:	US
Telephone Number	:	847-818-9250
Fax Number	:	847-818-9239

Authorized Official
Title or Position	:	DDS
Name	:	OKSANA SEMENY
Credential	:
Telephone Number	:	773-875-6195

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	01/12/2021

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