Healthcare Provider Details

I. General information

NPI: 1730127226
Provider Name (Legal Business Name): FOX VALLEY ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 MERCHANT DR
ALGONQUIN IL
60102-5917
US

IV. Provider business mailing address

1497 MERCHANT DR
ALGONQUIN IL
60102
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-4020
  • Fax: 847-658-4727
Mailing address:
  • Phone: 847-658-4020
  • Fax: 847-658-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21S747
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANDREW P TRAPANI
Title or Position: OWNER
Credential: D.D.S. MS
Phone: 847-658-4020