Provider Demographics
NPI:1700296233
Name:TWIN OAKS ORTHODONTICS
Entity Type:Organization
Organization Name:TWIN OAKS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-434-8800
Mailing Address - Street 1:6440 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1752
Mailing Address - Country:US
Mailing Address - Phone:630-434-8800
Mailing Address - Fax:630-434-9157
Practice Address - Street 1:6440 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1752
Practice Address - Country:US
Practice Address - Phone:630-434-8800
Practice Address - Fax:630-434-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019014774251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare