Provider Demographics
NPI:1295379691
Name:ORTHODONTIC EXPERTS, LTD
Entity Type:Organization
Organization Name:ORTHODONTIC EXPERTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:REINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-904-2984
Mailing Address - Street 1:1351 N LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3753
Mailing Address - Country:US
Mailing Address - Phone:847-749-4340
Mailing Address - Fax:
Practice Address - Street 1:1351 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3753
Practice Address - Country:US
Practice Address - Phone:847-749-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC EXPERTS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-30
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty