Id Orthodoctics LLC

NPI #1629541636 in Grayslake, Illinois

Provider Information

NPI Number: 1629541636
Entity Type: Organization
Organization Name: Id Orthodoctics LLC
Primary Specialty: Dentist
Enumeration Date: Jan 3, 2019
Last Updated: Jan 3, 2019

Practice Location

Address: 1275 E BELVIDERE RD STE 100
City: Grayslake
State: Illinois
ZIP Code: 60030-2080
Phone: (847) 548-4200

Authorized Official

Name: MIKE COLE
Title: VP INSURANCE PLAN MANAGEMENT
Phone: (941) 955-3150

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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