Provider Demographics
NPI:1033457312
Name:JOHN ORTHODONTICS
Entity Type:Organization
Organization Name:JOHN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS; MS
Authorized Official - Phone:954-575-3313
Mailing Address - Street 1:4651 N STATE ROAD 7 UNIT 1314
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4378
Mailing Address - Country:US
Mailing Address - Phone:954-575-3313
Mailing Address - Fax:
Practice Address - Street 1:4651 N STATE ROAD 7 UNIT 1314
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4378
Practice Address - Country:US
Practice Address - Phone:954-575-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 178091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty