Organization
MYORTHOS ILLINOIS ORTHODONTICS PC
Active
Organization
MYORTHOS ILLINOIS ORTHODONTICS PC
Active
Parent organization
MYORTHOS ILLINOIS ORTHODONTICS PC
Other names
Premier Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
MYORTHOS ILLINOIS ORTHODONTICS PC
Authorized official
CASEY LONABOCKER (VP OPERATIONS & STRATEGY)
(617) 535-3364
Entity
Organization
Contact information
Practice address
1704 POLARIS CIR, OTTAWA, IL 61350-1773
(815) 434-4222
Mailing address
131 DARTMOUTH ST FL 3, BOSTON, MA 02116-5297
(617) 535-3305
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
06/09/2022
Last updated
11/20/2024
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