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General NPI Number Information
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NPI Number | 1750648564
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Entity Type | Organization
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Legal Business Name | HENTSCHER-JOHNSON ORTHODONTICS
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 200 E MILL ST
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City | WATERLOO
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State | IL
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Zip | 62298-1519
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Country | US
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Telephone | 618-939-2900
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Fax | 888-908-5295
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Provider Business Mailing Address
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Address Line | 200 E MILL ST
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City | WATERLOO
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State | IL
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Zip | 62298-1519
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Country | US
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Telephone | 618-939-2900
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Fax | 888-908-5295
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Authorized Official
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Title or Position | DENTIST/ORTHODONTIST
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Name | DR. JODI KAY HENTSCHER-JOHNSON
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Credential | D.M.D., M.S.
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Telephone | 618-939-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.028038
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License Number State | IL
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