Provider Demographics
NPI:1003077413
Name:TOR, OTTO JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:OTTO
Middle Name:JAMES
Last Name:TOR
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 1:15614 S HARLEM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4402
Mailing Address - Country:US
Mailing Address - Phone:708-614-1111
Mailing Address - Fax:
Practice Address - Street 1:15614 S HARLEM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4402
Practice Address - Country:US
Practice Address - Phone:708-614-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0144201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice