Provider Demographics
NPI:1679775407
Name:ORAL KARE NETWORK LLL
Entity Type:Organization
Organization Name:ORAL KARE NETWORK LLL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORIDNATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-HOLDERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-585-5176
Mailing Address - Street 1:4020 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4512
Mailing Address - Country:US
Mailing Address - Phone:773-585-5176
Mailing Address - Fax:773-585-5188
Practice Address - Street 1:4020 W 59TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4512
Practice Address - Country:US
Practice Address - Phone:773-585-5176
Practice Address - Fax:773-585-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental