Provider Demographics
NPI:1528408945
Name:IMBURGIA ORTHODONTICS LLC
Entity Type:Organization
Organization Name:IMBURGIA ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBURGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-997-7930
Mailing Address - Street 1:2230 STAFFORD RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2789
Mailing Address - Country:US
Mailing Address - Phone:317-296-5388
Mailing Address - Fax:
Practice Address - Street 1:2230 STAFFORD RD
Practice Address - Street 2:SUITE 157
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2789
Practice Address - Country:US
Practice Address - Phone:317-296-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-29
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty