GLEN ELLYN ORTHODONTICS PC NPI 1063954477

NPI Information

  • NPI: 1063954477
  • Provider Name: GLEN ELLYN ORTHODONTICS, PC
  • Classification: Clinic/Center - 261QD0000X
  • Specialization: Dental
  • Entity Type: Organization
  • Doing Business As: WARDELL ORTHODONTICS
  • Address: 45 S PARK BLVD
    SUITE 220
    GLEN ELLYN, IL
    ZIP 60137
  • Phone: (630) 469-6200

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NPI Details

GLEN ELLYN ORTHODONTICS, PC is a dental clinic center in Glen Ellyn, IL. GLEN ELLYN ORTHODONTICS, PC NPI is 1063954477. The provider is registered as an organization entity type.
The provider Is Doing Business As Wardell Orthodontics.

The provider's business location address is:

45 S PARK BLVD
SUITE 220
GLEN ELLYN, IL
ZIP 60137-280
Phone: (630) 469-6200
Fax: (630) 469-6203

The provider's authorized official is Bruce S. Wardell .
The authorized official title is President and has the following contact phone number (630) 697-0334.

The enumeration date for this NPI number is 11/16/2016 and was last updated on 11/16/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QD0000XClinic/CenterDental021.002325ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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