IDENTITY ORTHODONTICS (NPI# 1619375144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619375144 |
| Entity Type | Organization |
| Organization Name | IDENTITY ORTHODONTICS |
| Practice Address |
1275 E Belvidere Rd Ste 100 Grayslake IL 60030-2080 |
| Mailing Address |
1275 E Belvidere Rd Grayslake IL 60030-2082 |
| Practice Telephone | 8475484200 |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |
| Authorized Official Name | MICHAEL STOSICH (OWNER) |
| Authorized Official Telephone | 8475484200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers |
| Street Address |
1275 E BELVIDERE RD STE 100 |
| City | GRAYSLAKE |
| State | IL |
| Zip Code | 60030-2080 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629541636 | Id Orthodoctics LLC | Dentist | 1275 E Belvidere Rd Ste 100, Grayslake, IL 60030-2080 | 2019-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891393781 | Camelot Care Centers, LLC | Clinic/Center | 34121 North Route 45 Suite 207, Grayslake, IL 60030 | 2020-10-13 |
| 1992347892 | Pier London | Social Worker | 18640 Belivdere Rd., Grayslake, IL 60030 | 2019-10-11 |
| 1972156529 | Elizabeth Reeve | Counselor | 18640 Belvidere, Grayslake, IL 60030 | 2019-07-23 |
| 1144725987 | Michael Kraft | Family Medicine | 1475 E. Belvidere Road, Suite 385, Grayslake, IL 60030 | 2018-03-26 |
| 1255850780 | Megan B March | Speech-Language Pathologist | 33089 N Battershall Rd, Grayslake, IL 60030 | 2017-09-15 |
| 1669992665 | Easy Oxygen Inc. | Durable Medical Equipment & Medical Supplies | 1862 E Belvidere Road #125, Grayslake, IL 60030 | 2017-06-21 |
| 1184163628 | Surprenant Chiropractic LLC | Clinic/Center | 1227 N Illinois Route 83, Suite A, Grayslake, IL 60030 | 2017-02-16 |
| 1700230976 | Camelot Care Centers, LLC. | Foster Care Agency | 34121 North Route 45, Suite 207, Grayslake, IL 60030 | 2016-04-14 |
| 1932560414 | Vital Therapeutics Inc | Physical Therapist | 34121 N Us 45, Suite 101, Grayslake, IL 60030 | 2016-03-11 |
| 1093175804 | Zigma Visiting Physician, LLC | General Practice | 4 N Deer Point Dr, 1002, Hainesville, IL 60030 | 2016-03-07 |
| Find all providers in zip 60030 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538438304 | Donald James Reily | Dentist | 30 North Slusser Street, Grayslake, IL 60030 | 2011-12-22 |
| 1366724502 | Michael S Stosich | Dentist | 1275 E Belvidere Rd, Suite 100, Grayslake, IL 60030-2082 | 2011-09-14 |
| 1225276900 | Terry A Sellke | Dentist | 30 N Slusser St, Grayslake, IL 60030-3662 | 2009-02-03 |
| 1578777447 | David Richard Hertzberg | Dentist | 160 Commerce Dr, Suite 101, Grayslake, IL 60030-1601 | 2007-05-10 |
| 1841346962 | Drs. Sellke and Reily, Ltd. | Dentist | 30 N Slusser St, Grayslake, IL 60030-3662 | 2007-01-25 |
| 1306805726 | Grayslake Orthodontics Inc | Dentist | 160 Commerce Dr, Suite 101, Grayslake, IL 60030-1601 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427670421 | Braces By Barnes | Dentist | 1335 E 87th St Ste B, Chicago, IL 60619-7036 | 2020-05-12 |
| 1790310431 | Gregory D Long II | Dentist | 7131 N Knoxville Ave Ste B, Peoria, IL 61614-2088 | 2020-03-03 |
| 1073147682 | Collinsville Orthodontics Pllc | Dentist | 93 Crestmoor St, Collinsville, IL 62234-4952 | 2020-02-24 |
| 1740812494 | Bankhead Alton Orthodontics PC | Dentist | 2828 Homer Adams Pkwy, Alton, IL 62002-4855 | 2020-02-11 |
| 1336779164 | Orthodontic Experts, Ltd | Dentist | 2987 Kirk Rd Ste 103a, Aurora, IL 60502-6014 | 2020-01-21 |
| 1922645308 | Riddhi J Desai Dmd Pllc | Dentist | 727 W Madison St Apt 1208, Chicago, IL 60661-2409 | 2019-12-04 |
| 1295379691 | Orthodontic Experts, Ltd | Dentist | 1351 N Larkin Ave, Joliet, IL 60435-3753 | 2019-10-30 |
| 1407409071 | Barysenka LLC | Dentist | 124 N California St, Sycamore, IL 60178-1402 | 2019-07-22 |
| 1346806577 | Pulaski Smiling Dental P.C. | Dentist | 5540 S Pulaski Rd Fl 1, Chicago, IL 60629-4418 | 2019-05-13 |
| 1750944252 | Candid Illinois, Pllc | Dentist | 750 N Franklin St Fl Stc2, Chicago, IL 60654-6263 | 2019-04-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.