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General NPI Number Information
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NPI Number | 1306527981
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Entity Type | Organization
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Legal Business Name | SPOONHOWER ORTHODONTICS LLC
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 1410 BOETTLER RD
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City | UNIONTOWN
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State | OH
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Zip | 44685-9584
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Country | US
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Telephone | 330-896-0600
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Fax | 330-896-0601
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Provider Business Mailing Address
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Address Line | 1410 BOETTLER RD
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City | UNIONTOWN
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State | OH
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Zip | 44685-9584
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Country | US
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Telephone | 330-896-0600
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Fax | 330-896-0601
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Authorized Official
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Title or Position | SR CREDENTIALING LEAD
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Name | JENNY GARCIA-ROCHA
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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