Provider Demographics
NPI:1518558907
Name:MYORTHOS CONNECTICUT ORTHODONTICS PC
Entity Type:Organization
Organization Name:MYORTHOS CONNECTICUT ORTHODONTICS PC
Other - Org Name:CTBRACES ORANGE ORTHODONTICS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-863-2186
Mailing Address - Street 1:301 EDGEWATER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1281
Mailing Address - Country:US
Mailing Address - Phone:617-535-3305
Mailing Address - Fax:
Practice Address - Street 1:131 DARTMOUTH ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5297
Practice Address - Country:US
Practice Address - Phone:617-863-2186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty