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NPI Code Detail

MEDICARE: MY ORTHODONTIST

MEDICARE: MY ORTHODONTIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryDS018685LPA

General Provider Information

NPI Number : 1548452097
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY ORTHODONTIST
Provider Business Mailing Address
First Line : 532 S OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2615
Country : US
Telephone Number : 215-946-0800
Fax Number :
Provider Business Practice Location Address
First Line : 532 S OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2615
Country : US
Telephone Number : 215-946-0800
Fax Number :
Authorized Official
Title or Position : INSURANCE MANAGER
Name : LISA RADER
Credential :
Telephone Number : 215-946-3655
Provider Enumeration Date : 08/17/2007
Last Update Date : 08/17/2007

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532 S OXFORD VALLEY RD
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1184905317 — LISA RADER DMD
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1730432287 — INFINITY DENTAL MANAGEMENT LLC
Practice Location Address:
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Practice Fax: 215-946-1041

Directions to “MY ORTHODONTIST ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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