Provider Demographics
NPI:1043470107
Name:OREAD ORTHODONTICS LLC
Entity Type:Organization
Organization Name:OREAD ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-856-2483
Mailing Address - Street 1:1425 WAKARUSA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-856-2483
Mailing Address - Fax:866-614-9189
Practice Address - Street 1:1425 WAKARUSA DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3832
Practice Address - Country:US
Practice Address - Phone:785-856-2483
Practice Address - Fax:866-614-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty