Healthcare Provider Details

I. General information

NPI: 1265119820
Provider Name (Legal Business Name): MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 JOHN ROBERT THOMAS DR
EXTON PA
19341
US

IV. Provider business mailing address

132 JOHN ROBERT THOMAS DR
EXTON PA
19341
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-2900
  • Fax: 610-363-7722
Mailing address:
  • Phone: 610-363-2900
  • Fax: 610-363-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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