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General NPI Number Information
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NPI Number | 1134393382
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Entity Type | Organization
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Legal Business Name | OLGA LEAHY DDS PC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 4242 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60639-3647
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Country | US
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Telephone | 773-384-1998
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Fax | 847-251-4149
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Provider Business Mailing Address
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Address Line | 4242 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60639-3647
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Country | US
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Telephone | 773-384-1998
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Fax | 847-251-4149
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Authorized Official
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Title or Position | DENTIST
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Name | DR. OLGA LEAHY
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Credential | D.D.S.
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Telephone | 773-384-1998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19A14612
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License Number State | IL
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