Provider Demographics
NPI:1497261648
Name:ORTHODONTIC EXPERTS OF COLORADO, PLLC
Entity Type:Organization
Organization Name:ORTHODONTIC EXPERTS OF COLORADO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BZDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-801-7171
Mailing Address - Street 1:1250 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1685 BRIARGATE BLVD STE B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3417
Practice Address - Country:US
Practice Address - Phone:847-749-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC EXPERTS OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-26
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00203373Medicaid