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General NPI Number Information
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NPI Number | 1023161817
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Entity Type | Organization
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Legal Business Name | ORTHODONTICS FOR ALL AGES, P.C.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE SUITE 1330
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City | CHICAGO
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State | IL
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Zip | 60611-2615
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Country | US
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Telephone | 312-266-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 737 N MICHIGAN AVE SUITE 1330
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City | CHICAGO
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State | IL
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Zip | 60611-2615
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Country | US
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Telephone | 312-266-7118
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. RUDOLFO M VALENTE
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Credential | DDS
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Telephone | 312-266-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | IL
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