Provider Demographics
NPI:1194031609
Name:MOUNTAIN VIEW ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-466-5300
Mailing Address - Street 1:378 ROUTE 518
Mailing Address - Street 2:SUITE B
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:378 ROUTE 518
Practice Address - Street 2:SUITE B
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2256
Practice Address - Country:US
Practice Address - Phone:609-466-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021874001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty