Provider Demographics
NPI:1508047804
Name:F.A.BOOTH DDS,MS,PA
Entity Type:Organization
Organization Name:F.A.BOOTH DDS,MS,PA
Other - Org Name:STOUT&BOOTH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-484-8191
Mailing Address - Street 1:222 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5512
Mailing Address - Country:US
Mailing Address - Phone:910-484-8191
Mailing Address - Fax:910-484-0502
Practice Address - Street 1:222 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5512
Practice Address - Country:US
Practice Address - Phone:910-484-8191
Practice Address - Fax:910-484-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty