Provider Demographics
NPI:1548408438
Name:FOREST ORTHODONTICS AND PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:FOREST ORTHODONTICS AND PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOKHI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-234-6641
Mailing Address - Street 1:810 S WAUKEGAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:847-615-5437
Mailing Address - Fax:847-615-2955
Practice Address - Street 1:810 S WAUKEGAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:847-615-5437
Practice Address - Fax:847-615-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210021501223P0221X
IL0210022191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty