Organization
MYORTHOS ILLINOIS ORTHODONTICS PC
Active
Parent organization
MYORTHOS ILLINOIS ORTHODONTICS PC
Other names
Prose 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
2055 FOXFIELD RD, ST CHARLES, IL 60174-1442
(630) 584-6555
Mailing address
2055 FOXFIELD RD, ST CHARLES, IL 60174-1442
(630) 584-6555
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
11/20/2024
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