Prairie Orthodontics PC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

06006486 Issued in IL

Legal business name

PRAIRIE ORTHODONTICS PC

Practice address

6121 Washington St
Suite 204
Gurnee, IL 60031

Phone

(847) 249-8800

Fax

(847) 249-8869

NPI assigned

Nov 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Bridget O Mueller

Title

Office Manager

Phone

(847) 249-8800

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033284831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6121 WASHINGTON ST",
            "address_2": "SUITE 204",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-249-8800",
            "fax_number": "847-249-8869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 WASHINGTON ST",
            "address_2": "SUITE 204",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-249-8800",
            "fax_number": "847-249-8869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE ORTHODONTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-249-8800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "06006486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.