Provider Demographics
NPI:1780845933
Name:ONIK, JEFFREY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:ONIK
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 1:230 E 8TH ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3081
Mailing Address - Country:US
Mailing Address - Phone:815-838-6102
Mailing Address - Fax:815-838-6281
Practice Address - Street 1:230 E 8TH ST
Practice Address - Street 2:SUITE #5
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3081
Practice Address - Country:US
Practice Address - Phone:815-838-6102
Practice Address - Fax:815-838-6281
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568467702OtherGROUP NPI