Provider Demographics
NPI:1205220241
Name:SIMPLY STRAIGHT, P.C.
Entity Type:Organization
Organization Name:SIMPLY STRAIGHT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-859-3353
Mailing Address - Street 1:12 ALVORD ST
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1152
Mailing Address - Country:US
Mailing Address - Phone:732-859-3353
Mailing Address - Fax:
Practice Address - Street 1:1502 WILLIAMSON RD NE
Practice Address - Street 2:#1000 A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5130
Practice Address - Country:US
Practice Address - Phone:540-206-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty