Healthcare Provider Details

I. General information

NPI: 1104331255
Provider Name (Legal Business Name): ORTHODONTIC EXPERTS OF COLORADO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W CROSS DR STE 426
LITTLETON CO
80123-0760
US

IV. Provider business mailing address

1250 W NORTHWEST HWY
MOUNT PROSPECT IL
60056-2274
US

V. Phone/Fax

Practice location:
  • Phone: 847-749-4340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MONIKA BZDAL
Title or Position: MANAGER
Credential:
Phone: 773-801-7171