Provider Demographics
NPI:1427564897
Name:OCDC, LLC
Entity Type:Organization
Organization Name:OCDC, LLC
Other - Org Name:OAK CREEK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-762-9010
Mailing Address - Street 1:132 E DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2123
Mailing Address - Country:US
Mailing Address - Phone:414-762-9010
Mailing Address - Fax:
Practice Address - Street 1:132 E DREXEL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2123
Practice Address - Country:US
Practice Address - Phone:414-762-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6560261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental