Provider Demographics
NPI:1487764049
Name:ORTHODONTIC ASSOCIATES, PLC
Entity type:Organization
Organization Name:ORTHODONTIC ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:STORIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:423-282-2333
Mailing Address - Street 1:801 SUNSET DR BLDG E # 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3033
Mailing Address - Country:US
Mailing Address - Phone:423-282-2333
Mailing Address - Fax:423-282-9337
Practice Address - Street 1:801 SUNSET DR BLDG E # 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3033
Practice Address - Country:US
Practice Address - Phone:423-282-2333
Practice Address - Fax:423-282-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty