Provider Demographics
NPI:1942472279
Name:OFELIA POD, DMD, PC
Entity type:Organization
Organization Name:OFELIA POD, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-444-8888
Mailing Address - Street 1:1520 CARLEMONT DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1834
Mailing Address - Country:US
Mailing Address - Phone:815-444-8888
Mailing Address - Fax:815-444-8890
Practice Address - Street 1:1520 CARLEMONT DR
Practice Address - Street 2:SUITE E
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1834
Practice Address - Country:US
Practice Address - Phone:815-444-8888
Practice Address - Fax:815-444-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty