Healthcare Provider Details

I. General information

NPI: 1689598260
Provider Name (Legal Business Name): TARIQ OURI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CONVENIENCE PL STE A
CHAMPAIGN IL
61820-8927
US

IV. Provider business mailing address

9560 140TH CT APT 312
ORLAND PARK IL
60462-1219
US

V. Phone/Fax

Practice location:
  • Phone: 217-355-5165
  • Fax:
Mailing address:
  • Phone: 708-491-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: