Provider Demographics
NPI:1538849096
Name:MYORTHOS ILLINOIS ORTHODONTICS PC
Entity type:Organization
Organization Name:MYORTHOS ILLINOIS ORTHODONTICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS & STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONABOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-535-3364
Mailing Address - Street 1:290 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1518
Mailing Address - Country:US
Mailing Address - Phone:847-367-1640
Mailing Address - Fax:
Practice Address - Street 1:290 CENTER DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1518
Practice Address - Country:US
Practice Address - Phone:847-367-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYORTHOS ILLINOIS ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty