Provider Demographics
NPI:1417256009
Name:OHMART ORTHODONTICS
Entity Type:Organization
Organization Name:OHMART ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-713-1950
Mailing Address - Street 1:7960 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3166
Mailing Address - Country:US
Mailing Address - Phone:303-713-1950
Mailing Address - Fax:303-713-1166
Practice Address - Street 1:7960 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3166
Practice Address - Country:US
Practice Address - Phone:303-713-1950
Practice Address - Fax:303-713-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty