Healthcare Provider Details

I. General information

NPI: 1902882103
Provider Name (Legal Business Name): C. NEIL KAY ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOULDER HILL PASS
MONTGOMERY IL
60538-1911
US

IV. Provider business mailing address

25 BOULDER HILL PASS
MONTGOMERY IL
60538-1911
US

V. Phone/Fax

Practice location:
  • Phone: 630-896-2779
  • Fax: 630-896-9252
Mailing address:
  • Phone: 630-896-2779
  • Fax: 630-896-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021001221
License Number StateIL

VIII. Authorized Official

Name: DR. C. NEIL KAY
Title or Position: OWNER/DOCTOR
Credential: BDS, MS
Phone: 630-896-2779