| Identity Orthodontics | |
|
1275 E Belvidere Rd Ste 100 Grayslake IL 60030-2080 | |
| (847) 548-4200 | |
| Not Available |
| Full Name | Identity Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1275 E Belvidere Rd Ste 100, Grayslake, Illinois |
| Authorized Official Name and Position | Michael Stosich (OWNER) |
| Authorized Official Contact | 8475484200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Identity Orthodontics 1275 E Belvidere Rd Grayslake IL 60030-2082 Ph: () - | Identity Orthodontics 1275 E Belvidere Rd Ste 100 Grayslake IL 60030-2080 Ph: (847) 548-4200 |
| NPI Number | 1619375144 |
|---|---|
| Provider Enumeration Date | 12/16/2014 |
| Last Update Date | 12/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619375144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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