MEDICARE: MAURA O'CONNOR HELLMICH RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	020.006052	IL

General Provider Information

NPI Number	:	1063015998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA O'CONNOR HELLMICH RDH

Provider Business Mailing Address
First Line	:	8459 W HILLSIDE DR
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-2058
Country	:	US
Telephone Number	:	708-567-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	8459 W HILLSIDE DR
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-2058
Country	:	US
Telephone Number	:	708-567-5201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	11/22/2020

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