Provider Demographics
NPI:1902897481
Name:ORAL KARE NETWORK LOC #2 LTD
Entity Type:Organization
Organization Name:ORAL KARE NETWORK LOC #2 LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVENINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-656-2441
Mailing Address - Street 1:5907 WEST 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804
Mailing Address - Country:US
Mailing Address - Phone:708-656-2441
Mailing Address - Fax:708-656-2515
Practice Address - Street 1:5907 WEST 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804
Practice Address - Country:US
Practice Address - Phone:708-656-2441
Practice Address - Fax:708-656-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004943Medicaid