Organization
ASHBECK ORTHODONTIC ASSOCIATES INC
Active
Other names
North Shore Orthodontic Associates
Organization subpart
No
Provider details
NPI number
Authorized official
BRYON KOZAK DDS MS (PRESIDENT OWNER)
(847) 234-4400
Entity
Organization
Contact information
Practice address
225 E DEERPATH RD STE 280, LAKE FOREST, IL 60045-1973
(847) 234-4400
(847) 234-4403
Mailing address
225 E DEERPATH RD STE 280, LAKE FOREST, IL 60045-1973
(847) 234-4400
(847) 234-4403
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104946912
NPI
IL
01
—
1407925050
NPI
IL
01
—
1689743247
NPI
IL
Enumeration date
11/29/2006
Last updated
02/12/2008
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