Provider Demographics
NPI:1457421166
Name:CENTRAL DUPAGE ORTHODONTICS, LTD.
Entity type:Organization
Organization Name:CENTRAL DUPAGE ORTHODONTICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-665-3317
Mailing Address - Street 1:300 S. WEST STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-665-3317
Mailing Address - Fax:630-665-3979
Practice Address - Street 1:300 S. WEST STREET
Practice Address - Street 2:STE 2
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-665-3317
Practice Address - Fax:630-665-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty