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General NPI Number Information
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NPI Number | 1194264903
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Entity Type | Organization
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Legal Business Name | INTEGRAL ORTHODONTICS, LTD
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 379 N SEYMOUR AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-2322
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Country | US
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Telephone | 847-970-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 379 N SEYMOUR AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-2322
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Country | US
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Telephone | 847-970-3000
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. NATALY M ARBOLEDA
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Credential |
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Telephone | 954-907-4492
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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 |
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