Provider Demographics
NPI:1790497147
Name:ORTHODONTIC EXPERTS OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:ORTHODONTIC EXPERTS OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BZDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-340-1046
Mailing Address - Street 1:1700 E HIGGINS RD STE 320
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N81W15180 APPLETON AVE STE B
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3841
Practice Address - Country:US
Practice Address - Phone:262-421-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC EXPERTS OF WISCONSIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty