Provider Demographics
NPI:1245834084
Name:ORTHODONTIC EXPERTS OF WISCONSIN, LLC
Entity type:Organization
Organization Name:ORTHODONTIC EXPERTS OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BZDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-801-7171
Mailing Address - Street 1:1250 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2692 CRANSTON RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6908
Practice Address - Country:US
Practice Address - Phone:855-720-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty