Healthcare Provider Details

I. General information

NPI: 1962021139
Provider Name (Legal Business Name): JORDAN ELMOWITZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S RAND RD
LAKE ZURICH IL
60047-3409
US

IV. Provider business mailing address

660 S RAND RD
LAKE ZURICH IL
60047-3409
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-4190
  • Fax:
Mailing address:
  • Phone: 847-367-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019032670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: