Provider Demographics
NPI:1851840276
Name:SPOT ON MYO
Entity Type:Organization
Organization Name:SPOT ON MYO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-316-1610
Mailing Address - Street 1:6645 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2625
Mailing Address - Country:US
Mailing Address - Phone:708-316-1610
Mailing Address - Fax:
Practice Address - Street 1:11555 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2300
Practice Address - Country:US
Practice Address - Phone:708-316-1610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020009281124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty