Organization
INNOVATIVE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ALVAN GORDON JR. DMD (TREASURER)
(630) 878-0351
Entity
Organization
Contact information
Practice address
1000 W JEFFERSON ST STE 101, JOLIET, IL 60435-6812
(814) 727-5813
Mailing address
1905 MARKETVIEW DR UNIT 274, YORKVILLE, IL 60560-1896
(630) 878-0351
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019020648
IL
Other
Enumeration date
12/20/2013
Last updated
12/23/2013
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