Provider Demographics
NPI:1629601877
Name:THE ORTHODONTISTS AT HILLSBOROUGH
Entity Type:Organization
Organization Name:THE ORTHODONTISTS AT HILLSBOROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WELCH FIDONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-493-2268
Mailing Address - Street 1:13808 W MAPLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6231
Mailing Address - Country:US
Mailing Address - Phone:402-493-2268
Mailing Address - Fax:402-905-0372
Practice Address - Street 1:13808 W MAPLE RD STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-6231
Practice Address - Country:US
Practice Address - Phone:402-493-2268
Practice Address - Fax:402-905-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty