Provider Demographics
NPI:1407146574
Name:WINDY CITY ORTHODONTICS, LTD.
Entity Type:Organization
Organization Name:WINDY CITY ORTHODONTICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKRAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:773-697-8038
Mailing Address - Street 1:2921 N LINCOLN AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8618
Mailing Address - Country:US
Mailing Address - Phone:773-697-8038
Mailing Address - Fax:773-435-6343
Practice Address - Street 1:2921 N LINCOLN AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8618
Practice Address - Country:US
Practice Address - Phone:773-697-8038
Practice Address - Fax:773-435-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty