Provider Demographics
NPI:1134393382
Name:OLGA LEAHY DDS PC
Entity type:Organization
Organization Name:OLGA LEAHY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-384-1998
Mailing Address - Street 1:4242 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3647
Mailing Address - Country:US
Mailing Address - Phone:773-384-1998
Mailing Address - Fax:847-251-4149
Practice Address - Street 1:4242 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3647
Practice Address - Country:US
Practice Address - Phone:773-384-1998
Practice Address - Fax:847-251-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14612261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental