Provider Demographics
NPI:1538672563
Name:NORTH VALLEY ORTHODONTICS - RAINTREE PLLC
Entity Type:Organization
Organization Name:NORTH VALLEY ORTHODONTICS - RAINTREE PLLC
Other - Org Name:NORTH VALLEY ORTHODONTICS - RAINTREE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:480-419-2222
Mailing Address - Street 1:21050 N TATUM BLVD STE D202
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4262
Mailing Address - Country:US
Mailing Address - Phone:480-419-2222
Mailing Address - Fax:
Practice Address - Street 1:9360 E RAINTREE DR STE 107
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2099
Practice Address - Country:US
Practice Address - Phone:480-419-2222
Practice Address - Fax:480-419-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty