Provider Demographics
NPI:1689131559
Name:KNOX FAMILY ORTHODONTICS LLC
Entity Type:Organization
Organization Name:KNOX FAMILY ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZNY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-831-0056
Mailing Address - Street 1:455 N BROAD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-6763
Mailing Address - Country:US
Mailing Address - Phone:708-831-0056
Mailing Address - Fax:
Practice Address - Street 1:506 KNOX SQUARE DR STE 10
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-8663
Practice Address - Country:US
Practice Address - Phone:309-565-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental