Provider Demographics
NPI:1285754341
Name:AMERICAN FORK ORTHODONTICS PC
Entity type:Organization
Organization Name:AMERICAN FORK ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:801-756-6246
Mailing Address - Street 1:36 S 1100 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2835
Mailing Address - Country:US
Mailing Address - Phone:801-756-6246
Mailing Address - Fax:801-756-8774
Practice Address - Street 1:36 S 1100 E
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2835
Practice Address - Country:US
Practice Address - Phone:801-756-6246
Practice Address - Fax:801-756-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty