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General NPI Number Information
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NPI Number | 1699232017
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC EXPERTS LTD
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 17759 HALSTED ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2009
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Country | US
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Telephone | 708-405-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 17759 HALSTED ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2009
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Country | US
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Telephone | 708-405-2122
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MONIKA BZDAL
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Credential |
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Telephone | 773-609-5007
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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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