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General NPI Number Information
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NPI Number | 1841143567
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC EXPERTS OF INDIANA, LLC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 5997 CENTRAL AVE
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City | PORTAGE
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State | IN
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Zip | 46368-2944
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Country | US
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Telephone | 219-232-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 5997 CENTRAL AVE
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City | PORTAGE
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State | IN
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Zip | 46368-2944
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Country | US
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Telephone | 219-232-9056
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Fax |
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Authorized Official
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Title or Position | VP
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Name | IRENA RAKHMETZYANOV
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Credential |
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Telephone | 224-628-0322
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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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