Provider Demographics
NPI:1003108945
Name:FASTTRAX ORTHODONTICS
Entity Type:Organization
Organization Name:FASTTRAX ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-548-8200
Mailing Address - Street 1:2720 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4916
Mailing Address - Country:US
Mailing Address - Phone:972-548-8200
Mailing Address - Fax:972-548-1230
Practice Address - Street 1:2720 VIRGINIA PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4916
Practice Address - Country:US
Practice Address - Phone:972-548-8200
Practice Address - Fax:972-548-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253181223S0112X
TX142301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2023160-04Medicaid