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General NPI Number Information
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NPI Number | 1679775407
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Entity Type | Organization
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Legal Business Name | ORAL KARE NETWORK LLL
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4020 W 59TH ST
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City | CHICAGO
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State | IL
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Zip | 60629-4512
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Country | US
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Telephone | 773-585-5176
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Fax | 773-585-5188
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Provider Business Mailing Address
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Address Line | 4020 W 59TH ST
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City | CHICAGO
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State | IL
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Zip | 60629-4512
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Country | US
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Telephone | 773-585-5176
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Fax | 773-585-5188
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Authorized Official
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Title or Position | OFFICE COORIDNATOR
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Name | MS. GUADALUPE GONZALEZ-HOLDERBAUM
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Credential |
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Telephone | 773-585-5176
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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 |
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License Number State |
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