Provider Demographics
NPI:1790081396
Name:MOSES LAKE ORTHODONTICS LLC
Entity Type:Organization
Organization Name:MOSES LAKE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:509-869-0999
Mailing Address - Street 1:8710 E WOODLAD PARK DR
Mailing Address - Street 2:C/O PRAMOD SINHA
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217
Mailing Address - Country:US
Mailing Address - Phone:509-892-3706
Mailing Address - Fax:
Practice Address - Street 1:825 SHARON AVE E
Practice Address - Street 2:MOSES LAKE ORTHODONTICS LLC
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2441
Practice Address - Country:US
Practice Address - Phone:509-766-9030
Practice Address - Fax:509-534-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60307289200100011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty