Provider Demographics
NPI:1194401901
Name:MIDLANDS ORTHODONTICS LLC
Entity type:Organization
Organization Name:MIDLANDS ORTHODONTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-784-2721
Mailing Address - Street 1:2300 LAKEVIEW PARKWAY, STE. 250
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009
Mailing Address - Country:US
Mailing Address - Phone:727-784-2721
Mailing Address - Fax:
Practice Address - Street 1:1212 HWY 9 BYPASS WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-716-9623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDLANDS ORTHODONTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-26
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty