Provider Demographics
NPI:1679648265
Name:ROOD, NATHANIEL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:STEPHEN
Last Name:ROOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ORLAND SQUARE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6558
Mailing Address - Country:US
Mailing Address - Phone:708-460-7440
Mailing Address - Fax:708-403-1945
Practice Address - Street 1:62 ORLAND SQUARE DR STE 104
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6558
Practice Address - Country:US
Practice Address - Phone:708-460-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190261271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice