Provider Demographics
NPI:1184466914
Name:O'KASICK, COLIN E (DMD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:E
Last Name:O'KASICK
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 1:2650 BOBWHITE LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5947
Mailing Address - Country:US
Mailing Address - Phone:630-441-0941
Mailing Address - Fax:
Practice Address - Street 1:112 N 4TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2125
Practice Address - Country:US
Practice Address - Phone:630-232-4076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190351371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice