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General NPI Number Information
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NPI Number | 1457421166
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Entity Type | Organization
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Legal Business Name | CENTRAL DUPAGE ORTHODONTICS, LTD.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 300 S. WEST STREET STE 2
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City | WHEATON
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State | IL
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Zip | 60187
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Country | US
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Telephone | 630-665-3317
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Fax | 630-665-3979
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Provider Business Mailing Address
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Address Line | 300 S. WEST STREET STE 2
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City | WHEATON
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State | IL
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Zip | 60187
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Country | US
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Telephone | 630-665-3317
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Fax | 630-665-3979
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | LAURENCE A GOLDEN
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Credential |
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Telephone | 630-665-3317
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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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