MEDICARE: ODED GARGIR 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	122300000X	Dentist	019021096	IL

General Provider Information

NPI Number	:	1184859852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODED GARGIR DDS PC

Provider Business Mailing Address
First Line	:	3442 RIDGE RD
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-3102
Country	:	US
Telephone Number	:	708-889-9442
Fax Number	:

Provider Business Practice Location Address
First Line	:	3442 RIDGE RD
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-3102
Country	:	US
Telephone Number	:	708-889-9442
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ODED GARGIR
Credential	:	DDS
Telephone Number	:	708-889-9442

Provider Enumeration Date	:	05/23/2009
Last Update Date	:	05/23/2009

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