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General NPI Number Information
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NPI Number | 1508376708
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Entity Type | Organization
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Legal Business Name | GLANDER ROCHFORD ORTHODONTICS, LLC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 8445 S EMERSON AVE STE 102
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9597
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Country | US
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Telephone | 317-888-2827
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Fax |
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Provider Business Mailing Address
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Address Line | 8445 S EMERSON AVE STE 102
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9597
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Country | US
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Telephone | 317-888-2827
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. BRIAN TIMOTHY ROCHFORD
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Credential | DDS, MSD
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Telephone | 317-888-2827
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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 | 12012198A
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License Number State | IN
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