Provider Demographics
NPI:1992247084
Name:OTHMAN ORTHODONTICS INC
Entity type:Organization
Organization Name:OTHMAN ORTHODONTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:FAWWAZ
Authorized Official - Last Name:OTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:630-424-9070
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-424-9070
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:STE 310
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-424-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02100220271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty