Provider Demographics
NPI:1497086367
Name:WINDERMERE ORTHODONTICS LLC
Entity Type:Organization
Organization Name:WINDERMERE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORLOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:770-888-1929
Mailing Address - Street 1:3120 MATHIS AIRPORT PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9128
Mailing Address - Country:US
Mailing Address - Phone:770-888-1929
Mailing Address - Fax:770-888-1859
Practice Address - Street 1:3120 MATHIS AIRPORT PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9128
Practice Address - Country:US
Practice Address - Phone:770-888-1929
Practice Address - Fax:770-888-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty