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NPI Code Detail

MEDICARE: DR. RAMEL ODISHO DMD

MEDICARE: DR. RAMEL ODISHO DMD
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
1122300000XDentist019033595IL

General Provider Information

NPI Number : 1255063632
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAMEL ODISHO DMD
Provider Business Mailing Address
First Line : 3224 HARRISON ST
Second Line :
City : GLENVIEW
State : IL
Zip : 60025-4556
Country : US
Telephone Number : 847-903-8393
Fax Number :
Provider Business Practice Location Address
First Line : 3143 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-1424
Country : US
Telephone Number : 773-465-2922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2022
Last Update Date : 06/25/2022

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Directions to “ DR. RAMEL ODISHO DMD” Practice Location

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