Provider Demographics
NPI:1730127226
Name:FOX VALLEY ORTHODONTICS PC
Entity Type:Organization
Organization Name:FOX VALLEY ORTHODONTICS PC
Other - Org Name:TRAPANI ORTHODONTICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:TRAPANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:847-658-4020
Mailing Address - Street 1:1497 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102
Mailing Address - Country:US
Mailing Address - Phone:847-658-4020
Mailing Address - Fax:847-658-4727
Practice Address - Street 1:1497 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-658-4020
Practice Address - Fax:847-658-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21S7471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty