Provider Demographics
NPI:1437358132
Name:ONTARIO ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:ONTARIO ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-394-2830
Mailing Address - Street 1:90 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1232
Mailing Address - Country:US
Mailing Address - Phone:585-394-2830
Mailing Address - Fax:585-394-4244
Practice Address - Street 1:90 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1232
Practice Address - Country:US
Practice Address - Phone:585-394-2830
Practice Address - Fax:585-394-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049589-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty