MEDICARE: NADIA ODISH DDS

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	19-026568	IL

General Provider Information

NPI Number	:	1578546909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA ODISH DDS

Provider Business Mailing Address
First Line	:	8118 N MILWAUKEE AVE
Second Line	:	SUITE100
City	:	NILES
State	:	IL
Zip	:	60714-2817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8118 N MILWAUKEE AVE
Second Line	:	SUITE100
City	:	NILES
State	:	IL
Zip	:	60714-2817
Country	:	US
Telephone Number	:	847-692-0900
Fax Number	:	847-692-0904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	01/19/2010

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