Provider Demographics
NPI:1639862295
Name:OCEANSIDE ORTHODONTICS PA
Entity Type:Organization
Organization Name:OCEANSIDE ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OVY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-951-0850
Mailing Address - Street 1:421 SW 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3553
Mailing Address - Country:US
Mailing Address - Phone:305-951-0850
Mailing Address - Fax:
Practice Address - Street 1:2300 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3587
Practice Address - Country:US
Practice Address - Phone:305-951-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty