Individual
OLIVIA A LARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 975-1600
Mailing address
1001 W 15TH ST UNIT 224, CHICAGO, IL 60608-2765
(312) 493-7988
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
190.028310
IL
Other
Enumeration date
06/28/2010
Last updated
06/28/2010
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