Healthcare Provider Details

I. General information

NPI: 1215987599
Provider Name (Legal Business Name): ORTHODONTICS LIMITED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 WELSH ROAD SUITE 1B
PHILADELPHIA PA
19115
US

IV. Provider business mailing address

2137 WELSH ROAD SUITE 1B
PHILADELPHIA PA
19115
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-7846
  • Fax: 215-676-9384
Mailing address:
  • Phone: 215-676-7846
  • Fax: 215-676-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025198L
License Number StatePA

VIII. Authorized Official

Name: HAROLD L MIDDLEBERG
Title or Position: PRESIDENT
Credential: DMD
Phone: 215-676-7846