| South Park Ortho Pllc | |
|
401 W Talcott Rd Park Ridge IL 60068-5408 | |
| (847) 318-7711 | |
| Not Available |
| Full Name | South Park Ortho Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 401 W Talcott Rd, Park Ridge, Illinois |
| Authorized Official Name and Position | Robert Cory Stites (INSURANCE COORDINATOR-DECISION ONE) |
| Authorized Official Contact | 6308695857 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Park Ortho Pllc 1699 E Woodfield Rd Ste 102 Schaumburg IL 60173-4955 Ph: (630) 869-5857 | South Park Ortho Pllc 401 W Talcott Rd Park Ridge IL 60068-5408 Ph: (847) 318-7711 |
| NPI Number | 1396319711 |
|---|---|
| Provider Enumeration Date | 05/19/2021 |
| Last Update Date | 05/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396319711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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