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General NPI Number Information
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NPI Number | 1902897481
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Entity Type | Organization
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Legal Business Name | ORAL KARE NETWORK LOC #2 LTD
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5907 WEST 35TH ST
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City | CICERO
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State | IL
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Zip | 60804
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Country | US
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Telephone | 708-656-2441
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Fax | 708-656-2515
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Provider Business Mailing Address
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Address Line | 5907 WEST 35TH ST
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City | CICERO
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State | IL
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Zip | 60804
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Country | US
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Telephone | 708-656-2441
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Fax | 708-656-2515
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARLEEN SEVENINO
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Credential |
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Telephone | 708-656-2441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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