MEDICARE: GET IT STRAIGHT ORTHODONTICS HYDE PARK PC

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		IL

General Provider Information

NPI Number	:	1861566929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GET IT STRAIGHT ORTHODONTICS HYDE PARK PC

Provider Business Mailing Address
First Line	:	2122 STRATFORD LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5745
Country	:	US
Telephone Number	:	773-752-6691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 E 53RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4542
Country	:	US
Telephone Number	:	773-752-6691
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEIL M WARSHAWSKY
Credential	:	DDS
Telephone Number	:	773-752-6691

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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