Provider Demographics
NPI:1962717314
Name:OTTO J. TOR, D.D.S., LTD.
Entity type:Organization
Organization Name:OTTO J. TOR, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-614-1111
Mailing Address - Street 1:15614 S HARLEM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4402
Mailing Address - Country:US
Mailing Address - Phone:708-614-1111
Mailing Address - Fax:708-614-1117
Practice Address - Street 1:15614 S HARLEM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4402
Practice Address - Country:US
Practice Address - Phone:708-614-1111
Practice Address - Fax:708-614-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190144201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty