Glen Ellyn Orthodontic Associates, P.C.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

019-014235 Issued in IL

Legal business name

GLEN ELLYN ORTHODONTIC ASSOCIATES, P.C.

Practice address

507 Duane St
Glen Ellyn, IL 60137-4549

Phone

(630) 469-5225

Fax

(630) 469-5443

NPI assigned

May 23, 2007

Last updated

Jan 8, 2009By 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

Dr. Douglas Robert Prince, DDS,MS,PC

Title

Owner

Phone

(630) 469-5225

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1811107998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 DUANE ST",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374549",
            "telephone_number": "630-469-5225",
            "fax_number": "630-469-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 DUANE ST",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374549",
            "telephone_number": "630-469-5225",
            "fax_number": "630-469-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ELLYN ORTHODONTIC ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "PRINCE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-469-5225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,MS,PC"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "019-014235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glen Ellyn C C School Dist 89
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• 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 Orthodontics, PC (Wardell Orthodontics)
• 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

• Orthodontics and Dentofacial Orthopedics Dentistry in Glen Ellyn, IL
• Providers in Glen Ellyn, 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 Jan 8, 2009; 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.