Provider Demographics
NPI:1508376708
Name:GLANDER ROCHFORD ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:GLANDER ROCHFORD ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:ROCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-888-2827
Mailing Address - Street 1:8445 S EMERSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9597
Mailing Address - Country:US
Mailing Address - Phone:317-888-2827
Mailing Address - Fax:
Practice Address - Street 1:8445 S EMERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9597
Practice Address - Country:US
Practice Address - Phone:317-888-2827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012198A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty