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NPI Code Detail

MEDICARE: ORAL KARE NETWORK LLL

MEDICARE: ORAL KARE NETWORK LLL
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1679775407
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORAL KARE NETWORK LLL
Provider Business Mailing Address
First Line : 4020 W 59TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4512
Country : US
Telephone Number : 773-585-5176
Fax Number : 773-585-5188
Provider Business Practice Location Address
First Line : 4020 W 59TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4512
Country : US
Telephone Number : 773-585-5176
Fax Number : 773-585-5188
Authorized Official
Title or Position : OFFICE COORIDNATOR
Name : MS. GUADALUPE GONZALEZ-HOLDERBAUM
Credential :
Telephone Number : 773-585-5176
Provider Enumeration Date : 06/04/2007
Last Update Date : 08/22/2020

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Directions to “ORAL KARE NETWORK LLL ” Practice Location

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