MEDICARE: DR. EDWARD JOHN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	021-000625	IL

General Provider Information

NPI Number	:	1265847859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JOHN D.D.S.

Provider Business Mailing Address
First Line	:	1420 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4824
Country	:	US
Telephone Number	:	847-255-3020
Fax Number	:	847-255-3036

Provider Business Practice Location Address
First Line	:	1420 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4824
Country	:	US
Telephone Number	:	847-255-3020
Fax Number	:	847-255-3036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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