Provider Demographics
NPI:1457199044
Name:PRIME ORTHODONTICS PLLC
Entity type:Organization
Organization Name:PRIME ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-869-9916
Mailing Address - Street 1:3120 KILN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5648
Mailing Address - Country:US
Mailing Address - Phone:757-327-4843
Mailing Address - Fax:757-234-8891
Practice Address - Street 1:1933 EDWIN DR STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6531
Practice Address - Country:US
Practice Address - Phone:757-547-2134
Practice Address - Fax:757-410-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty