Provider Demographics
NPI:1003407271
Name:FAMILY ORTHODONTICS, INC
Entity Type:Organization
Organization Name:FAMILY ORTHODONTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-872-3072
Mailing Address - Street 1:5 MOUNT ROYAL AVE., SUITE 300 OPTIONAL
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-872-3072
Mailing Address - Fax:
Practice Address - Street 1:80 WORCESTER STREET
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536
Practice Address - Country:US
Practice Address - Phone:508-366-7976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY ORTHODONTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty