Healthcare Provider Details

I. General information

NPI: 1609348283
Provider Name (Legal Business Name): SHIRCK ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 N HIGH ST BLDG D
NEW ALBANY OH
43054-8091
US

IV. Provider business mailing address

68 N HIGH ST BLDG D
NEW ALBANY OH
43054-8091
US

V. Phone/Fax

Practice location:
  • Phone: 614-855-9110
  • Fax:
Mailing address:
  • Phone: 614-855-9110
  • 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: MRS. ZHENIA SHIRCK
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-855-9110