Provider Demographics
NPI:1760262935
Name:MYORTHOS MASSACHUSETTS ORTHODONTICS PC
Entity Type:Organization
Organization Name:MYORTHOS MASSACHUSETTS ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR RCM
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-843-1393
Mailing Address - Street 1:131 DARTMOUTH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5297
Mailing Address - Country:US
Mailing Address - Phone:617-665-7241
Mailing Address - Fax:617-665-7241
Practice Address - Street 1:3 CRANE PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1788
Practice Address - Country:US
Practice Address - Phone:413-596-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYORTHOS MASSACHUSETTS ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty