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General NPI Number Information
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NPI Number | 1861601619
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Entity Type | Organization
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Legal Business Name | TINLEY PARK ORTHODONTIC ASSOCIATES
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15234 S HARLEM AVE
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City | ORLAND PARK
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State | IL
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Zip | 60462-4330
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Country | US
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Telephone | 708-614-9420
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Fax |
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Provider Business Mailing Address
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Address Line | 15234 HARLEM
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City | ORLAND PARK
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State | IL
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Zip | 60462
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS PRINCE
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Credential | D.D.S.
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Telephone | 708-614-9420
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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 | IL
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