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General NPI Number Information
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NPI Number | 1245834084
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC EXPERTS OF WISCONSIN, LLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 2692 CRANSTON RD
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City | BELOIT
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State | WI
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Zip | 53511-6908
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Country | US
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Telephone | 855-720-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 W NORTHWEST HWY
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-2274
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SUPPORT SERVICES
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Name | MONIKA BZDAL
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Credential |
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Telephone | 773-801-7171
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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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