Provider Demographics
NPI:1568511665
Name:ONO, CLYDE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:H
Last Name:ONO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3732
Mailing Address - Country:US
Mailing Address - Phone:847-476-0491
Mailing Address - Fax:
Practice Address - Street 1:3217 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1080
Practice Address - Country:US
Practice Address - Phone:847-853-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist