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General NPI Number Information
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NPI Number | 1871462366
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Entity Type | Organization
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Legal Business Name | ORIGIN ORTHODONTICS PLLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 7800 CURLEY RD # 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545
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Country | US
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Telephone | 813-544-7686
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Fax |
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Provider Business Mailing Address
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Address Line | 1053 SYLVIA LN
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City | TAMPA
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State | FL
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Zip | 33613-2005
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Country | US
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Telephone | 813-955-2837
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. IOANNA ULRICH
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Credential | DMD, MDS
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Telephone | 813-955-2837
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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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