Provider Demographics
NPI:1558084129
Name:PA ORTHODONTICS, PPLLC
Entity Type:Organization
Organization Name:PA ORTHODONTICS, PPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-308-8181
Mailing Address - Street 1:15 ENGLE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2920
Mailing Address - Country:US
Mailing Address - Phone:201-308-8181
Mailing Address - Fax:
Practice Address - Street 1:227 DRYDEN RD E
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1015
Practice Address - Country:US
Practice Address - Phone:267-607-3050
Practice Address - Fax:888-292-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty