Provider Demographics
NPI:1215107966
Name:ORLAND PARK DENTAL SERVICES
Entity type:Organization
Organization Name:ORLAND PARK DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ONDOY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-226-0091
Mailing Address - Street 1:8120 KATY LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6112
Mailing Address - Country:US
Mailing Address - Phone:708-226-0091
Mailing Address - Fax:
Practice Address - Street 1:809 W DETWEILLER DR
Practice Address - Street 2:SUITE 805A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2149
Practice Address - Country:US
Practice Address - Phone:309-692-1320
Practice Address - Fax:309-692-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty