Provider Demographics
NPI:1518538164
Name:MCCAFFREY ORTHODONTICS LLC
Entity Type:Organization
Organization Name:MCCAFFREY ORTHODONTICS LLC
Other - Org Name:MCCAFFREY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SENIOR TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:VICENTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:6736 FOREST HILL BLVD.
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413
Mailing Address - Country:US
Mailing Address - Phone:561-964-5200
Mailing Address - Fax:
Practice Address - Street 1:6736 FOREST HILL BLVD.
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33413
Practice Address - Country:US
Practice Address - Phone:561-964-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty