MEDICARE: DR. FREDERICK J ORENDACH 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 A13187	IL

General Provider Information

NPI Number	:	1750449039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK J ORENDACH DDS

Provider Business Mailing Address
First Line	:	7101 ARCHER AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2203
Country	:	US
Telephone Number	:	773-586-6622
Fax Number	:	773-586-6622

Provider Business Practice Location Address
First Line	:	7101 ARCHER AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2203
Country	:	US
Telephone Number	:	773-586-6622
Fax Number	:	773-586-6622

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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