=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083837611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERZNER ORTHODONTICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 OLD ORCHARD SHOPPING CTR SUITE 410
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-676-2270
-----------------------------------------------------
Fax | 847-676-2304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 OLD ORCHARD SHOPPING CTR SUITE 410
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-676-2270
-----------------------------------------------------
Fax | 847-676-2304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. SHOEL KERZNER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 847-676-2270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------