Provider Demographics
NPI:1154703288
Name:HOMETOWN ORTHODONTICS PLLC
Entity type:Organization
Organization Name:HOMETOWN ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RUCHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-693-9077
Mailing Address - Street 1:495 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5348
Mailing Address - Country:US
Mailing Address - Phone:716-693-9077
Mailing Address - Fax:
Practice Address - Street 1:3040 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5835
Practice Address - Country:US
Practice Address - Phone:716-534-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524051223X0400X
NY0547531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty