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General NPI Number Information
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NPI Number | 1235056441
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Entity Type | Organization
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Legal Business Name | CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 799 ROOSEVELT RD, BUILDING 4, STE 100
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5908
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Country | US
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Telephone | 630-756-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 799 ROOSEVELT RD BUILDING 4, STE 100
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5908
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Country | US
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Telephone | 630-756-5151
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN WELKE
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Credential | DDS
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Telephone | 630-886-1780
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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