Provider Demographics
NPI:1972715043
Name:NWI ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:NWI ORTHODONTICS, INC.
Other - Org Name:ORTHODONTICS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOUFOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-922-7257
Mailing Address - Street 1:1630 45TH STREET
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3963
Mailing Address - Country:US
Mailing Address - Phone:219-922-7257
Mailing Address - Fax:219-922-7258
Practice Address - Street 1:1630 45TH STREET
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3963
Practice Address - Country:US
Practice Address - Phone:219-922-7257
Practice Address - Fax:219-922-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty