Provider Demographics
NPI:1255070181
Name:OGANDO DDS LLC
Entity type:Organization
Organization Name:OGANDO DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-252-5772
Mailing Address - Street 1:1229 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2204
Mailing Address - Country:US
Mailing Address - Phone:773-252-5772
Mailing Address - Fax:773-278-0543
Practice Address - Street 1:1229 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2204
Practice Address - Country:US
Practice Address - Phone:773-252-5772
Practice Address - Fax:773-278-0543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OGANDO DDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental