Provider Demographics
NPI:1124332556
Name:FAIRVIEW-ALLEN ORTHODONTICS, PA
Entity type:Organization
Organization Name:FAIRVIEW-ALLEN ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-727-3900
Mailing Address - Street 1:431 STACY RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-8741
Mailing Address - Country:US
Mailing Address - Phone:972-727-3900
Mailing Address - Fax:
Practice Address - Street 1:431 STACY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-8741
Practice Address - Country:US
Practice Address - Phone:972-727-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty