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General NPI Number Information
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NPI Number | 1962832915
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Entity Type | Organization
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Legal Business Name | SAUK VALLEY ORTHODONTICS, PC
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 122 E EVERETT ST
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City | DIXON
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State | IL
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Zip | 61021-2140
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Country | US
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Telephone | 815-564-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 122 E EVERETT ST
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City | DIXON
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State | IL
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Zip | 61021-2140
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Country | US
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Telephone | 815-564-2294
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST, OWNER
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Name | DR. NEAL JONES
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Credential |
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Telephone | 815-564-2294
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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 | 019027845
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License Number State | IL
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