Provider Demographics
NPI:1740657774
Name:ORTHODONTIC EXPERTS
Entity type:Organization
Organization Name:ORTHODONTIC EXPERTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAROSLAV
Authorized Official - Middle Name:R
Authorized Official - Last Name:YARMOLYUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS , MS
Authorized Official - Phone:773-801-7174
Mailing Address - Street 1:4709 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4606
Mailing Address - Country:US
Mailing Address - Phone:773-801-7174
Mailing Address - Fax:773-830-7104
Practice Address - Street 1:1719 W 18TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4833
Practice Address - Country:US
Practice Address - Phone:773-801-7174
Practice Address - Fax:773-830-7104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC EXPERTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-25
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210024881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty