Provider Demographics
NPI:1346884335
Name:ORTHODONTICS OF ST. GEORGE, P.C.
Entity Type:Organization
Organization Name:ORTHODONTICS OF ST. GEORGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-592-0482
Mailing Address - Street 1:4760 N BUTLER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-0816
Mailing Address - Country:US
Mailing Address - Phone:505-592-0482
Mailing Address - Fax:505-325-2538
Practice Address - Street 1:965 E 700 S STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4084
Practice Address - Country:US
Practice Address - Phone:435-688-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty