Provider Demographics
NPI:1457635088
Name:WARREN ORTHODONTICS PC
Entity Type:Organization
Organization Name:WARREN ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-489-7878
Mailing Address - Street 1:485 S MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2290
Mailing Address - Country:US
Mailing Address - Phone:801-489-7878
Mailing Address - Fax:801-853-6321
Practice Address - Street 1:485 S MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2290
Practice Address - Country:US
Practice Address - Phone:801-489-7878
Practice Address - Fax:801-853-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370600-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty