Provider Demographics
NPI:1760969992
Name:YOUR ORTHODONTIST
Entity Type:Organization
Organization Name:YOUR ORTHODONTIST
Other - Org Name:YOUR ORTHODONTIST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-750-7779
Mailing Address - Street 1:586 MIDDLETOWN BLVD STE C10
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1880
Mailing Address - Country:US
Mailing Address - Phone:215-750-7779
Mailing Address - Fax:215-750-7848
Practice Address - Street 1:586 MIDDLETOWN BLVD STE C10
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-7779
Practice Address - Fax:215-750-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty