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NPI Code Detail

MEDICARE: ORAL KARE NETWORK, LOCATION II

MEDICARE: ORAL KARE NETWORK, LOCATION II
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
1122300000XDentistIL

General Provider Information

NPI Number : 1386650455
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORAL KARE NETWORK, LOCATION II
Provider Business Mailing Address
First Line : 5907 W 35TH ST
Second Line :
City : CICERO
State : IL
Zip : 60804-4163
Country : US
Telephone Number : 708-656-2441
Fax Number : 708-656-2515
Provider Business Practice Location Address
First Line : 5907 W 35TH ST
Second Line :
City : CICERO
State : IL
Zip : 60804-4163
Country : US
Telephone Number : 708-656-2441
Fax Number : 708-656-2515
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. MARLEEN SEVERINO
Credential :
Telephone Number : 708-656-2441
Provider Enumeration Date : 07/31/2006
Last Update Date : 02/25/2008

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Directions to “ORAL KARE NETWORK, LOCATION II ” Practice Location

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