Provider Demographics
NPI:1386303055
Name:COMMERCE ORTHODONTICS LLC
Entity type:Organization
Organization Name:COMMERCE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-335-0411
Mailing Address - Street 1:2340 LOGANVILLE HWY STE A101
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7853
Mailing Address - Country:US
Mailing Address - Phone:770-995-4032
Mailing Address - Fax:770-995-4034
Practice Address - Street 1:2025 HOMER RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1255
Practice Address - Country:US
Practice Address - Phone:706-335-0411
Practice Address - Fax:706-335-0041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CC ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental