Provider Demographics
NPI:1821366915
Name:NAPERVILLE ORTHODONTIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NAPERVILLE ORTHODONTIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-995-3547
Mailing Address - Street 1:25W380 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5806
Mailing Address - Country:US
Mailing Address - Phone:630-995-3547
Mailing Address - Fax:630-995-3547
Practice Address - Street 1:25W380 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5806
Practice Address - Country:US
Practice Address - Phone:630-995-3547
Practice Address - Fax:630-995-3547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0007841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty