=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457532202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONIK FAMILY DENTAL, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2007
-----------------------------------------------------
Last Update Date | 11/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7350 W COLLEGE DR SUITE 105
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-448-3323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7350 W COLLEGE DR SUITE 105
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-448-3323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CONNIE LEA ONIK
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 708-448-3323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------