Provider Demographics
NPI:1194485748
Name:HOMETOWN ORTHODONTICS
Entity type:Organization
Organization Name:HOMETOWN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:DEANNA
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:434-447-6481
Mailing Address - Street 1:6721 CRITTENDEN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23432-1609
Mailing Address - Country:US
Mailing Address - Phone:661-205-1764
Mailing Address - Fax:
Practice Address - Street 1:119 S MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2603
Practice Address - Country:US
Practice Address - Phone:434-447-6481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty