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General NPI Number Information
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NPI Number | 1295921500
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Entity Type | Organization
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Legal Business Name | O'HARE DENTAL GROUP
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | O'HARE INTERNATIONAL AIRPORT HILTON ARCADE LEVEL
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City | CHICAGO
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State | IL
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Zip | 60666
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Country | US
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Telephone | 773-601-8900
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Fax | 773-601-8988
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Provider Business Mailing Address
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Address Line | 11601 WEST TOUHY AVENUE O'HARE INTERNATIONAL AIRPORT-HILTON ARCADE LEVEL
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City | CHICAGO
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State | IL
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Zip | 60666
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Country | US
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Telephone | 773-601-8900
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Fax | 773-601-8988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY C RANIELI
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Credential | D.D.S.
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Telephone | 773-601-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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