Healthcare Provider Details

I. General information

NPI: 1376264754
Provider Name (Legal Business Name): NEW START ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

525 ROSE LN
HAVERFORD PA
19041-1625
US

IV. Provider business mailing address

525 ROSE LN
HAVERFORD PA
19041-1625
US

V. Phone/Fax

Practice location:
  • Phone: 215-869-5721
  • Fax:
Mailing address:
  • Phone: 215-869-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MCINTYRE
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 215-869-5721