Healthcare Provider Details

I. General information

NPI: 1255070181
Provider Name (Legal Business Name): OGANDO DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 N ASHLAND AVE
CHICAGO IL
60622-2204
US

IV. Provider business mailing address

1229 N ASHLAND AVE
CHICAGO IL
60622-2204
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-5772
  • Fax: 773-278-0543
Mailing address:
  • Phone: 773-252-5772
  • Fax: 773-278-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE KHALIFA
Title or Position: ADMIN
Credential:
Phone: 773-252-5772