Provider Demographics
NPI:1891915914
Name:FAITH ORTHODONTICS
Entity Type:Organization
Organization Name:FAITH ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:FAITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-837-5156
Mailing Address - Street 1:1645 IRVING PARK RD
Mailing Address - Street 2:202
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133
Mailing Address - Country:US
Mailing Address - Phone:630-837-5156
Mailing Address - Fax:630-837-5156
Practice Address - Street 1:1645 IRVING PARK RD
Practice Address - Street 2:202
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133
Practice Address - Country:US
Practice Address - Phone:630-837-5156
Practice Address - Fax:630-837-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty