Provider Demographics
NPI:1780122465
Name:O SEMENY DDS LTD
Entity type:Organization
Organization Name:O SEMENY DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-875-6195
Mailing Address - Street 1:5 E CAMP MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1527
Mailing Address - Country:US
Mailing Address - Phone:847-818-9250
Mailing Address - Fax:
Practice Address - Street 1:5 E CAMP MCDONALD RD
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1527
Practice Address - Country:US
Practice Address - Phone:847-818-9250
Practice Address - Fax:847-818-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190260151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780122465Medicaid