Provider Demographics
NPI:1235409806
Name:FIGUEROA ORTHODONTICS LLC
Entity Type:Organization
Organization Name:FIGUEROA ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-563-3000
Mailing Address - Street 1:1220 HOBSON RD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8139
Mailing Address - Country:US
Mailing Address - Phone:847-835-0871
Mailing Address - Fax:847-835-8945
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 228
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8139
Practice Address - Country:US
Practice Address - Phone:847-835-0871
Practice Address - Fax:847-835-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190189361223X0400X
IL0190278181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019018936Medicaid
IL019027818Medicaid