Provider Demographics
NPI:1124470257
Name:ORTHOZONE
Entity type:Organization
Organization Name:ORTHOZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PC
Authorized Official - Phone:770-974-3633
Mailing Address - Street 1:3104 CREEKSIDE VILLAGE DR NW
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2324
Mailing Address - Country:US
Mailing Address - Phone:770-974-3633
Mailing Address - Fax:770-974-3660
Practice Address - Street 1:3104 CREEKSIDE VILLAGE DR NW
Practice Address - Street 2:SUITE 401
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2324
Practice Address - Country:US
Practice Address - Phone:770-974-3633
Practice Address - Fax:770-974-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO139501223X0400X
GADNO127051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty