Provider Demographics
NPI:1093050205
Name:FOLEY ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS, P.C.
Entity Type:Organization
Organization Name:FOLEY ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS, P.C.
Other - Org Name:NORTHWEST ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:847-833-5365
Mailing Address - Street 1:820 S BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2421
Mailing Address - Country:US
Mailing Address - Phone:630-830-9700
Mailing Address - Fax:630-830-9739
Practice Address - Street 1:820 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2421
Practice Address - Country:US
Practice Address - Phone:630-830-9700
Practice Address - Fax:630-830-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0024681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty