Provider Demographics
NPI:1578133732
Name:JEFFERSON ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:JEFFERSON ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANKOO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-663-5397
Mailing Address - Street 1:3030 LBJ FWY STE 1400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2766
Mailing Address - Country:US
Mailing Address - Phone:972-444-8888
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ FWY STE 1400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2766
Practice Address - Country:US
Practice Address - Phone:972-444-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JDC HEALTHCARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty