Provider Demographics
NPI:1669624284
Name:PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
Entity type:Organization
Organization Name:PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE/INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-2900
Mailing Address - Street 1:4233 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2623
Mailing Address - Country:US
Mailing Address - Phone:708-636-2900
Mailing Address - Fax:708-636-3337
Practice Address - Street 1:4233 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2623
Practice Address - Country:US
Practice Address - Phone:708-636-2900
Practice Address - Fax:708-636-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-0011721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty