Healthcare Provider Details

I. General information

NPI: 1093647364
Provider Name (Legal Business Name): TWO FRONT ORTHODONTICS OH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 WOODLAWN AVE
CAMBRIDGE OH
43725-3025
US

IV. Provider business mailing address

3867 WELLAND AVE
LOS ANGELES CA
90008-1926
US

V. Phone/Fax

Practice location:
  • Phone: 424-309-8407
  • Fax:
Mailing address:
  • Phone: 424-309-8407
  • 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: ANNA LEE
Title or Position: BILLING OPERATIONS MANAGER
Credential:
Phone: 208-228-9210