Healthcare Provider Details

I. General information

NPI: 1740668177
Provider Name (Legal Business Name): NICOLE OPARAEKE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 S MICHIGAN AVE
CHICAGO IL
60605-2811
US

IV. Provider business mailing address

1454 S MICHIGAN AVE
CHICAGO IL
60605-2811
US

V. Phone/Fax

Practice location:
  • Phone: 312-698-0078
  • Fax: 312-698-0079
Mailing address:
  • Phone: 312-698-0078
  • Fax: 312-698-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019.033043
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: