Provider Demographics
NPI:1326416256
Name:INTEGRITY ORTHODONTICS
Entity Type:Organization
Organization Name:INTEGRITY ORTHODONTICS
Other - Org Name:CAVALLARO ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAVALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-971-9228
Mailing Address - Street 1:3823 ROSWELL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6278
Mailing Address - Country:US
Mailing Address - Phone:770-971-9228
Mailing Address - Fax:770-971-6162
Practice Address - Street 1:3823 ROSWELL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6278
Practice Address - Country:US
Practice Address - Phone:770-971-9228
Practice Address - Fax:770-971-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0103491223X0400X
GADN0137781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty