MEDICARE: WRIGLEYVILLE ORTHODONTICS P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1245571975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRIGLEYVILLE ORTHODONTICS P.C.

Provider Business Mailing Address
First Line	:	1353 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1401
Country	:	US
Telephone Number	:	847-770-8790
Fax Number	:

Authorized Official
Title or Position	:	RECEPTIONIST
Name	:	NERITA STRACHAN
Credential	:
Telephone Number	:	847-770-8790

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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