Active NPI
Samar Odeh
- Dentist
- Oak Lawn, IL
National Provider Identifier
1619420635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019030699
- Practice address
- 7117 W 93Rd St
Apt 201
Oak Lawn, IL 60453-2076 - Phone
- (217) 553-6460
- NPI assigned
- Jul 26, 2016
- Last updated
- Jul 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019030699 | IL | Primary |
Addresses
Primary practice location
7117 W 93Rd St
Apt 201
Oak Lawn, IL 60453-2076
Mailing address
7117 W 93Rd St
Apt 201
Oak Lawn, IL 60453-2076
Phone (217) 553-6460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030699 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469491200000",
"number": "1619420635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7117 W 93RD ST",
"address_2": "APT 201",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604532076",
"telephone_number": "217-553-6460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7117 W 93RD ST",
"address_2": "APT 201",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604532076",
"telephone_number": "217-553-6460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODEH",
"first_name": "SAMAR",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-26",
"last_updated": "2016-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019030699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Lawn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.