Provider Demographics
NPI:1477731297
Name:DEERFIELD ORTHODONTICS PC
Entity Type:Organization
Organization Name:DEERFIELD ORTHODONTICS PC
Other - Org Name:EISEN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:847-212-1250
Mailing Address - Street 1:710 ROBERT YORK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4343
Mailing Address - Country:US
Mailing Address - Phone:847-444-0022
Mailing Address - Fax:847-444-0033
Practice Address - Street 1:710 ROBERT YORK AVE STE A
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4343
Practice Address - Country:US
Practice Address - Phone:847-444-0022
Practice Address - Fax:847-444-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty