Identity Orthodontics

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

IDENTITY ORTHODONTICS

Practice address

1275 E Belvidere Rd Ste 100
Grayslake, IL 60030-2080

Phone

(847) 548-4200

NPI assigned

Dec 16, 2014

Organization subpart

No

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

Authorized official

Name

Michael Stosich

Title

Owner

Phone

(847) 548-4200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1619375144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 E BELVIDERE RD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 E BELVIDERE RD STE 100",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302080",
            "telephone_number": "847-548-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "STOSICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-548-4200"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Grayslake, IL
• Providers in Grayslake, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; 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.