Provider Demographics
NPI:1295921500
Name:O'HARE DENTAL GROUP
Entity type:Organization
Organization Name:O'HARE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:RANIELI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-601-8900
Mailing Address - Street 1:11601 WEST TOUHY AVENUE
Mailing Address - Street 2:O'HARE INTERNATIONAL AIRPORT-HILTON ARCADE LEVEL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60666
Mailing Address - Country:US
Mailing Address - Phone:773-601-8900
Mailing Address - Fax:773-601-8988
Practice Address - Street 1:O'HARE INTERNATIONAL AIRPORT
Practice Address - Street 2:HILTON ARCADE LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60666
Practice Address - Country:US
Practice Address - Phone:773-601-8900
Practice Address - Fax:773-601-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty