MEDICARE: MRS. RITA BAGDASARIAN-OLONO 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1902978422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA BAGDASARIAN-OLONO DDS

Provider Business Mailing Address
First Line	:	PO BOX 72158
Second Line	:
City	:	ROSELLE
State	:	IL
Zip	:	60172
Country	:	US
Telephone Number	:	630-310-7801
Fax Number	:	773-523-0702

Provider Business Practice Location Address
First Line	:	3113 SOUTH PULASKI
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623
Country	:	US
Telephone Number	:	773-523-0700
Fax Number	:	773-523-0702

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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