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General NPI Number Information
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NPI Number | 1275968406
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Entity Type | Organization
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Legal Business Name | NOVICK ORTHODONTICS
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 1950 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4204
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Country | US
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Telephone | 773-277-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 7351 NORTH AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1223
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Country | US
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Telephone | 708-366-2300
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Fax | 708-366-2595
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DARSHANA NOVICK
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Credential | DDS MS
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Telephone | 708-366-2300
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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 | 019026738
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License Number State | IL
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