Provider Demographics
NPI:1023535002
Name:BOOTH ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:BOOTH ORTHODONTICS PLLC
Other - Org Name:VERDE VALLEY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:928-634-2121
Mailing Address - Street 1:10 N ALAMOS DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4072
Mailing Address - Country:US
Mailing Address - Phone:928-634-2121
Mailing Address - Fax:928-634-4141
Practice Address - Street 1:10 N ALAMOS DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4072
Practice Address - Country:US
Practice Address - Phone:928-634-2121
Practice Address - Fax:928-634-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0093781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty