Provider Demographics
NPI:1588798912
Name:ORTHODONTIC SPECIALISTS, SC
Entity Type:Organization
Organization Name:ORTHODONTIC SPECIALISTS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCREATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-356-2151
Mailing Address - Street 1:1210 DRAPER ST
Mailing Address - Street 2:P.O. BOX 21
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1230
Mailing Address - Country:US
Mailing Address - Phone:608-356-2151
Mailing Address - Fax:608-356-2450
Practice Address - Street 1:1210 DRAPER ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1230
Practice Address - Country:US
Practice Address - Phone:608-356-2151
Practice Address - Fax:608-356-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42800151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty