Healthcare Provider Details

I. General information

NPI: 1710475546
Provider Name (Legal Business Name): PLYMOUTH ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 LONG POND RD
PLYMOUTH MA
02360-2670
US

IV. Provider business mailing address

51 LONG POND RD
PLYMOUTH MA
02360-2670
US

V. Phone/Fax

Practice location:
  • Phone: 508-815-1695
  • Fax: 833-427-3280
Mailing address:
  • Phone: 508-815-1695
  • Fax: 833-427-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1857505
License Number StateMA

VIII. Authorized Official

Name: DR. KARLA M ALVARADO
Title or Position: ORTHODONTIST
Credential: DMD, MSD
Phone: 508-815-1695