Provider Demographics
NPI:1508084294
Name:ORTHO 360, LLP
Entity Type:Organization
Organization Name:ORTHO 360, LLP
Other - Org Name:BASTROP ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:512-695-9404
Mailing Address - Street 1:301 HIGHWAY 71 W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4105
Mailing Address - Country:US
Mailing Address - Phone:512-321-1000
Mailing Address - Fax:512-332-2363
Practice Address - Street 1:301 HIGHWAY 71 W
Practice Address - Street 2:SUITE 201
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4105
Practice Address - Country:US
Practice Address - Phone:512-321-1000
Practice Address - Fax:512-332-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty