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General NPI Number Information
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NPI Number | 1457011082
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Entity Type | Organization
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Legal Business Name | MYORTHOS PENNSYLVANIA ORTHODONTICS PC
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2137 WELSH RD STE 1B
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4963
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Country | US
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Telephone | 215-676-7846
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Fax |
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Provider Business Mailing Address
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Address Line | 131 DARTMOUTH ST FL 3
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City | BOSTON
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State | MA
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Zip | 02116-5297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OPERATIONS & STRATEGY
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Name | CASEY LONABOCKER
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Credential |
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Telephone | 617-535-3364
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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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