Provider Demographics
NPI:1659422350
Name:ONDOY, ERIC C (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:ONDOY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 KATY LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6112
Mailing Address - Country:US
Mailing Address - Phone:708-226-0091
Mailing Address - Fax:702-226-0248
Practice Address - Street 1:8120 KATY LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6112
Practice Address - Country:US
Practice Address - Phone:708-226-0091
Practice Address - Fax:702-226-0248
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003179Medicaid