Provider Demographics
NPI:1649545575
Name:INNOVATIVE ORTHODONTICS, INC
Entity type:Organization
Organization Name:INNOVATIVE ORTHODONTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-878-0351
Mailing Address - Street 1:1905 MARKETVIEW DR
Mailing Address - Street 2:UNIT 274
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1896
Mailing Address - Country:US
Mailing Address - Phone:630-878-0351
Mailing Address - Fax:
Practice Address - Street 1:1905 MARKETVIEW DR
Practice Address - Street 2:UNIT 274
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1896
Practice Address - Country:US
Practice Address - Phone:630-878-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020648261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental