Provider Demographics
NPI:1508517756
Name:ROCKWALL ORTHODONTICS INC
Entity Type:Organization
Organization Name:ROCKWALL ORTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CAGLIOSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-226-9579
Mailing Address - Street 1:1460 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5500
Mailing Address - Country:US
Mailing Address - Phone:203-226-9579
Mailing Address - Fax:
Practice Address - Street 1:1460 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5500
Practice Address - Country:US
Practice Address - Phone:203-226-9579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty