Provider Demographics
NPI:1194562587
Name:RISE ORTHODONTIC STUDIO, PLLC
Entity type:Organization
Organization Name:RISE ORTHODONTIC STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-533-1349
Mailing Address - Street 1:102 W PALL MALL ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4067
Mailing Address - Country:US
Mailing Address - Phone:847-533-1349
Mailing Address - Fax:
Practice Address - Street 1:3119 VALLEY AVE STE 110
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2665
Practice Address - Country:US
Practice Address - Phone:847-533-1349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental