Provider Demographics
NPI:1235815291
Name:MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Entity Type:Organization
Organization Name:MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Other - Org Name:HENDRIX ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR RCM
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-843-1393
Mailing Address - Street 1:127 WEST STREET ROAD SUITE 201
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-9952
Mailing Address - Fax:610-444-9953
Practice Address - Street 1:127 WEST STREET ROAD SUITE 201
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-444-9952
Practice Address - Fax:610-444-9953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-26
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty