Provider Demographics
NPI:1275914632
Name:DR ORTHODONTICS PC
Entity Type:Organization
Organization Name:DR ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-288-0900
Mailing Address - Street 1:2560 DIXWELL AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1851
Mailing Address - Country:US
Mailing Address - Phone:203-288-0900
Mailing Address - Fax:
Practice Address - Street 1:2560 DIXWELL AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1851
Practice Address - Country:US
Practice Address - Phone:203-288-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007219261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental