Provider Demographics
NPI:1972075760
Name:ORTHODONTIC ASSOCIATES LLC
Entity type:Organization
Organization Name:ORTHODONTIC ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-961-6662
Mailing Address - Street 1:285 W KAAHUMANU AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1623
Mailing Address - Country:US
Mailing Address - Phone:808-874-9229
Mailing Address - Fax:
Practice Address - Street 1:505 FRONT ST STE 202
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761
Practice Address - Country:US
Practice Address - Phone:808-874-9229
Practice Address - Fax:808-961-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2024-11-08
Deactivation Date:2024-09-30
Deactivation Code:
Reactivation Date:2024-10-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty