Organization
BRICKYARD ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST PANOS D.D.S (PRESIDENT)
(773) 836-7846
Entity
Organization
Contact information
Practice address
6018 W DIVERSEY AVE, CHICAGO, IL 60639-1108
(773) 836-7846
(773) 622-6191
Mailing address
6018 W DIVERSEY AVE, CHICAGO, IL 60639-1108
(773) 836-7846
(773) 622-6191
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
IL
Other
Enumeration date
04/07/2008
Last updated
04/07/2008
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