Organization
SOUTH PARK ORTHO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT CORY STITES (INSURANCE COORDINATOR-DECISION ONE)
(630) 869-5857
Entity
Organization
Contact information
Practice address
401 W TALCOTT RD, PARK RIDGE, IL 60068-5408
(847) 318-7711
Mailing address
1699 E WOODFIELD RD STE 102, SCHAUMBURG, IL 60173-4955
(630) 869-5857
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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