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General NPI Number Information
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NPI Number | 1740657774
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC EXPERTS
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 1719 W 18TH ST
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City | CHICAGO
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State | IL
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Zip | 60608-4833
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Country | US
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Telephone | 773-801-7174
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Fax | 773-830-7104
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Provider Business Mailing Address
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Address Line | 4709 N HARLEM AVE
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City | HARWOOD HEIGHTS
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State | IL
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Zip | 60706-4606
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Country | US
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Telephone | 773-801-7174
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Fax | 773-830-7104
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. YAROSLAV R YARMOLYUK
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Credential | DDS , MS
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Telephone | 773-801-7174
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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 | 021002488
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License Number State | IL
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