Glen Ellyn Orthodontics, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

021.002325 Issued in IL

Legal business name

GLEN ELLYN ORTHODONTICS, PC

Doing business as

Wardell Orthodontics

Practice address

45 S Park Blvd
Suite 220
Glen Ellyn, IL 60137-6280

Phone

(630) 469-6200

Fax

(630) 469-6203

NPI assigned

Nov 16, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Bruce S. Wardell, DMDNPI 1437138047

Title

President

Phone

(630) 697-0334

Specialties & licenses 1

Addresses

Other names 1

• Wardell Orthodontics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bruce Sonnenberg Wardell, DMD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Glen Ellyn, IL
  • NPI 1437138047
  NPD (past) Authorized official

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1063954477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 S PARK BLVD",
            "address_2": "SUITE 220",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376280",
            "telephone_number": "630-469-6200",
            "fax_number": "630-469-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 S PARK BLVD",
            "address_2": "SUITE 220",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376280",
            "telephone_number": "630-469-6200",
            "fax_number": "630-469-6203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ELLYN ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-16",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "WARDELL",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-697-0334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "021.002325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wardell Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glen Ellyn Family Dental Care
• Glen Ellyn Family Eye Care Associates LTD
• Glen Ellyn Family Eye Care LLC (Glen Ellyn Family Eye Care)
• Glen Ellyn Ophthalmology Associates, LTD.
• Glen Ellyn Orthodontic Associates, P.C.
• Glen Ellyn Pediatric Dentistry ,P.C.. (Lance Lambert D.D.S., P.C.)
• Glen Ellyn Pharmacy Inc (Glen Ellyn Pharmacy Health Care Shoppes)
• Glen Ellyn Speech Therapy LLC
• Glen Ellyn Vision Center PC
• Glen Ellyn Youth and Family Counseling Service

• Dental Clinic/Center in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.