Provider Demographics
NPI:1114467354
Name:ORTHODONTIC CARE CENTER
Entity Type:Organization
Organization Name:ORTHODONTIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:630-420-4145
Mailing Address - Street 1:2547 PLAINFIELD NAPERVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8909
Mailing Address - Country:US
Mailing Address - Phone:630-420-4145
Mailing Address - Fax:630-420-7582
Practice Address - Street 1:2547 PLAINFIELD NAPERVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8909
Practice Address - Country:US
Practice Address - Phone:630-420-4145
Practice Address - Fax:630-420-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190295181223X0400X
IL0190190081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty