Provider Demographics
NPI:1972641785
Name:CHRISTINE MICHAELS DDS PC
Entity type:Organization
Organization Name:CHRISTINE MICHAELS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-851-5191
Mailing Address - Street 1:2500 HIGHLAND AVE
Mailing Address - Street 2:#100
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-889-8898
Mailing Address - Fax:630-889-8916
Practice Address - Street 1:2500 HIGHLAND AVE
Practice Address - Street 2:#100
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-889-8898
Practice Address - Fax:630-889-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID