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General NPI Number Information
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NPI Number | 1043457476
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Entity Type | Organization
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Legal Business Name | PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 10343 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1280
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Country | US
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Telephone | 815-469-7150
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Fax | 815-469-7152
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Provider Business Mailing Address
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Address Line | 10343 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1280
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Country | US
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Telephone | 815-469-7150
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Fax | 815-469-7152
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN C. BURKE
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Credential | D.D.S., M.S.
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Telephone | 815-469-7150
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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 | 021001977
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License Number State | IL
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