Provider Demographics
NPI:1467695817
Name:ORTHOGENESIS INTERNATIONAL CENTRE NORTH, PA
Entity Type:Organization
Organization Name:ORTHOGENESIS INTERNATIONAL CENTRE NORTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GARCIA-MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, PHD
Authorized Official - Phone:956-717-9877
Mailing Address - Street 1:6410 MCPHERSON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6191
Mailing Address - Country:US
Mailing Address - Phone:956-717-9877
Mailing Address - Fax:
Practice Address - Street 1:6410 MCPHERSON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6191
Practice Address - Country:US
Practice Address - Phone:956-717-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20718122300000X, 1223P0221X, 1223X0400X
TX20492122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty