Provider Demographics
NPI:1295387140
Name:CONCORD ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:CONCORD ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASWELL YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-224-3339
Mailing Address - Street 1:16 FOUNDRY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5431
Mailing Address - Country:US
Mailing Address - Phone:603-333-2538
Mailing Address - Fax:
Practice Address - Street 1:16 FOUNDRY ST STE 202
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5431
Practice Address - Country:US
Practice Address - Phone:603-333-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty