Provider Demographics
NPI:1083837611
Name:KERZNER ORTHODONTICS, PC
Entity Type:Organization
Organization Name:KERZNER ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KERZNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-676-2270
Mailing Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1425
Mailing Address - Country:US
Mailing Address - Phone:847-676-2270
Mailing Address - Fax:847-676-2304
Practice Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Practice Address - Street 2:SUITE 410
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-676-2270
Practice Address - Fax:847-676-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty