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NPI Code Detail

MEDICARE: NORTH SUBURBAN ORTHODONTICS, LTD

MEDICARE: NORTH SUBURBAN ORTHODONTICS, LTD
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry019026746IL

General Provider Information

NPI Number : 1710215611
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH SUBURBAN ORTHODONTICS, LTD
Provider Business Mailing Address
First Line : 6020 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1108
Country : US
Telephone Number : 773-237-0707
Fax Number :
Provider Business Practice Location Address
First Line : 6020 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1108
Country : US
Telephone Number : 773-237-0707
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. LOUIS A WHITESMAN
Credential : D.D.S., M.S
Telephone Number : 734-709-1363
Provider Enumeration Date : 12/03/2009
Last Update Date : 04/11/2013

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