Healthcare Provider Details

I. General information

NPI: 1194488353
Provider Name (Legal Business Name): MYORTHOS OHIO ORTHODONTICS - SALVATORE MANENTE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 OBSERVATORY AVE
CINCINNATI OH
45208-2108
US

IV. Provider business mailing address

131 DARTMOUTH ST FL 3
BOSTON MA
02116-5297
US

V. Phone/Fax

Practice location:
  • Phone: 513-533-4200
  • Fax:
Mailing address:
  • Phone:
  • 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