Healthcare Provider Details

I. General information

NPI: 1083343347
Provider Name (Legal Business Name): MYORTHOS MARYLAND ORTHODONTICS - LABBE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 WESLEY DR
SALISBURY MD
21801-7130
US

IV. Provider business mailing address

131 DARTMOUTH ST FL 3
BOSTON MA
02116-5297
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-2933
  • Fax: 410-749-0239
Mailing address:
  • Phone: 617-353-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CASEY LONABOCKER
Title or Position: VP OPERATIONS & STRATEGY
Credential:
Phone: 617-535-3364