MEDICARE: E L O DENTAL 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	122300000X	Dentist	019025096	IL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019018384	IL

General Provider Information

NPI Number	:	1144654468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E L O DENTAL PC

Provider Business Mailing Address
First Line	:	1328 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3401
Country	:	US
Telephone Number	:	847-818-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3401
Country	:	US
Telephone Number	:	847-818-0700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OSMAR RODRIGUEZ
Credential	:	DDS
Telephone Number	:	773-879-3400

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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Directions to “E L O DENTAL PC ” Practice Location

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