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NPI Code Detail

MEDICARE: LEWIS COUNTY ORTHODONTICS

MEDICARE: LEWIS COUNTY ORTHODONTICS
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 Dentistry

General Provider Information

NPI Number : 1831865583
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEWIS COUNTY ORTHODONTICS
Provider Business Mailing Address
First Line : 306 W LIBERTY ST
Second Line :
City : ROME
State : NY
Zip : 13440-5744
Country : US
Telephone Number : 845-562-2063
Fax Number :
Provider Business Practice Location Address
First Line : 91 LAKES RD STE 4
Second Line :
City : MONROE
State : NY
Zip : 10950-2694
Country : US
Telephone Number : 845-562-2063
Fax Number :
Authorized Official
Title or Position : FINANCIAL COORDINATOR
Name : KARMIE WILEY
Credential :
Telephone Number : 315-336-6380
Provider Enumeration Date : 08/20/2021
Last Update Date : 08/20/2021

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Directions to “LEWIS COUNTY ORTHODONTICS ” Practice Location

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