Provider Demographics
NPI:1346392586
Name:GORTHO LTD
Entity Type:Organization
Organization Name:GORTHO LTD
Other - Org Name:DR. GUY L BIBBS JR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-346-2575
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:#1400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-346-2575
Mailing Address - Fax:312-346-2583
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:#1400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-346-2575
Practice Address - Fax:312-346-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019161951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty