900 W Il Route 22, Suite 170, Lake Zurich, IL 60047
Phone
(847) 438-9090
Listed under
Individual orthodontists
NPI
1639503519
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Orthodontics and Dentofacial Orthopedics (1223X0400X)
Credentials listed
DMD, MS
License number on NPI record
021002474 (IL)
NPI first issued
Aug 27, 2013
NPI record last updated
Sep 12, 2022
NPI 1639503519 is active in the federal NPPES registry (CMS) with Orthodontics and Dentofacial Orthopedics, an ADA-recognized dental specialty, as its primary taxonomy; license 021002474 (IL) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Orthodontists are dentists who completed an accredited orthodontic residency after dental school. General dentists can also offer braces or aligners, but they are not listed here.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Orthodontics lists board-certified orthodontists.