Provider Demographics
NPI:1558415851
Name:POWER ORTHODONITCS
Entity Type:Organization
Organization Name:POWER ORTHODONITCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-220-0985
Mailing Address - Street 1:900 SE OCEAN BLVD SUITE 222C
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-2359
Mailing Address - Country:US
Mailing Address - Phone:772-220-0985
Mailing Address - Fax:772-324-6446
Practice Address - Street 1:900 SE OCEAN BLVD STE 222C
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3501
Practice Address - Country:US
Practice Address - Phone:772-220-0985
Practice Address - Fax:772-223-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 168171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty