Provider Demographics
NPI:1598000341
Name:NATHANIEL STEPHEN ROOD D.D.S., LTD.
Entity Type:Organization
Organization Name:NATHANIEL STEPHEN ROOD D.D.S., LTD.
Other - Org Name:ORLAND SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ROOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-460-7440
Mailing Address - Street 1:62 ORLAND SQUARE DR
Mailing Address - Street 2:SUITE #104
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6546
Mailing Address - Country:US
Mailing Address - Phone:708-460-7440
Mailing Address - Fax:
Practice Address - Street 1:62 ORLAND SQUARE DR
Practice Address - Street 2:SUITE #104
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6546
Practice Address - Country:US
Practice Address - Phone:708-460-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty