Healthcare Provider Details

I. General information

NPI: 1962465401
Provider Name (Legal Business Name): DR MARIA OSAN TOPALA AND ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2457 RIDGE RD
LANSING IL
60438-5214
US

IV. Provider business mailing address

2457 RIDGE RD PO BOX 5214
LANSING IL
60438-5214
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-0724
  • Fax: 708-895-0757
Mailing address:
  • Phone: 708-895-0724
  • Fax: 708-895-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number019-026244
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-015507
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number019-025539
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number019-020851
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.027062
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.026968
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-025781
License Number StateIL

VIII. Authorized Official

Name: MS. KATHY ANN KASPER
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 708-895-0724