Provider Demographics
NPI:1073749966
Name:GAINESVILLE ORTHODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:GAINESVILLE ORTHODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-719-9192
Mailing Address - Street 1:7504 IRON BAR LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2999
Mailing Address - Country:US
Mailing Address - Phone:703-719-5828
Mailing Address - Fax:703-691-9061
Practice Address - Street 1:7504 IRON BAR LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2999
Practice Address - Country:US
Practice Address - Phone:703-719-5828
Practice Address - Fax:703-691-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010035341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty