Organization
BOOTH ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN E BOOTH DDS, MSD (OWNER/ORTHODONTIST)
(708) 301-0005
Entity
Organization
Contact information
Practice address
12635 W 143RD ST, HOMER GLEN, IL 60491-8381
(708) 301-0005
Mailing address
12635 W 143RD ST, HOMER GLEN, IL 60491-8381
(708) 301-0005
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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