MEDICARE: O GUTERZON DDS LTD

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	019026015	IL

General Provider Information

NPI Number	:	1942516067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O GUTERZON DDS LTD

Provider Business Mailing Address
First Line	:	2806 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2806 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:	773-973-1100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OKSANA GUTERZON
Credential	:	DDS
Telephone Number	:	773-973-1100

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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