Provider Demographics
NPI:1215371505
Name:NORTH SUBURBAN ORTHODONTICS, LTD
Entity type:Organization
Organization Name:NORTH SUBURBAN ORTHODONTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-709-1363
Mailing Address - Street 1:1 W SUPERIOR ST
Mailing Address - Street 2:UNIT 2607
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8803
Mailing Address - Country:US
Mailing Address - Phone:734-709-1363
Mailing Address - Fax:
Practice Address - Street 1:4710 W 95TH ST
Practice Address - Street 2:UNIT B 10
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2546
Practice Address - Country:US
Practice Address - Phone:709-499-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty