Provider Demographics
NPI:1306004254
Name:GEORGE FAMILY ORTHODONTICS INC
Entity Type:Organization
Organization Name:GEORGE FAMILY ORTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:TINKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-761-5230
Mailing Address - Street 1:520 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3101
Mailing Address - Country:US
Mailing Address - Phone:508-336-3066
Mailing Address - Fax:
Practice Address - Street 1:520 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-3101
Practice Address - Country:US
Practice Address - Phone:508-336-3066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty