Provider Demographics
NPI:1477040087
Name:ALL ABOUT ORTHODONTICS PC
Entity Type:Organization
Organization Name:ALL ABOUT ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUTRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:586-999-9000
Mailing Address - Street 1:4600 E 14 MILE RD STE 3/4
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4369
Mailing Address - Country:US
Mailing Address - Phone:586-999-9000
Mailing Address - Fax:586-999-8000
Practice Address - Street 1:4600 E 14 MILE RD STE 3/4
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4369
Practice Address - Country:US
Practice Address - Phone:586-999-9000
Practice Address - Fax:586-999-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010221201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty