MEDICARE: OLGA LEAHY DDS PC

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	261QD0000X	Dental Clinic/Center	19A14612	IL

General Provider Information

NPI Number	:	1134393382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLGA LEAHY DDS PC

Provider Business Mailing Address
First Line	:	4242 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3647
Country	:	US
Telephone Number	:	773-384-1998
Fax Number	:	847-251-4149

Provider Business Practice Location Address
First Line	:	4242 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3647
Country	:	US
Telephone Number	:	773-384-1998
Fax Number	:	847-251-4149

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. OLGA LEAHY
Credential	:	D.D.S.
Telephone Number	:	773-384-1998

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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