Provider Demographics
NPI:1417628397
Name:MYORTHOS CONNECTICUT ORTHODONTICS, P.C.
Entity Type:Organization
Organization Name:MYORTHOS CONNECTICUT ORTHODONTICS, P.C.
Other - Org Name:BAUM BRACES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-535-3305
Mailing Address - Street 1:131 DARTMOUTH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5297
Mailing Address - Country:US
Mailing Address - Phone:617-535-3305
Mailing Address - Fax:
Practice Address - Street 1:23 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1612
Practice Address - Country:US
Practice Address - Phone:203-426-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYORTHOS CONNECTICUT ORTHODONTICS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-21
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty