Provider Demographics
NPI:1316493471
Name:ELKINS PARK ORTHODONTICS PC
Entity type:Organization
Organization Name:ELKINS PARK ORTHODONTICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIAWONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-635-0808
Mailing Address - Street 1:7900 OLD YORK RD
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2318
Mailing Address - Country:US
Mailing Address - Phone:215-808-6473
Mailing Address - Fax:215-638-0907
Practice Address - Street 1:7900 OLD YORK RD
Practice Address - Street 2:SUITE 108A
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2318
Practice Address - Country:US
Practice Address - Phone:215-808-6473
Practice Address - Fax:215-638-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0390861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty