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General NPI Number Information
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NPI Number | 1851840276
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Entity Type | Organization
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Legal Business Name | SPOT ON MYO
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 11555 S HARLEM AVE
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City | WORTH
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State | IL
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Zip | 60482-2300
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Country | US
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Telephone | 708-316-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 6645 VICTORIA DR
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City | OAK FOREST
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State | IL
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Zip | 60452-2625
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Country | US
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Telephone | 708-316-1610
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. JOY LANTZ
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Credential |
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Telephone | 708-316-1610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020009281
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License Number State | IL
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