Provider Demographics
NPI:1215361381
Name:PM ORTHODONTICS P.A.
Entity Type:Organization
Organization Name:PM ORTHODONTICS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-252-6763
Mailing Address - Street 1:9398 VISCOUNT BLVD
Mailing Address - Street 2:3A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-8056
Mailing Address - Country:US
Mailing Address - Phone:915-502-0277
Mailing Address - Fax:
Practice Address - Street 1:9398 VISCOUNT BLVD
Practice Address - Street 2:3A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-8056
Practice Address - Country:US
Practice Address - Phone:915-502-0277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213856201Medicaid