Provider Demographics
NPI:1811630551
Name:FAMILY ORTHODONTIC SPECIALISTS PLC
Entity Type:Organization
Organization Name:FAMILY ORTHODONTIC SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:14455 S ROBERT TRL
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4932
Mailing Address - Country:US
Mailing Address - Phone:651-423-6302
Mailing Address - Fax:
Practice Address - Street 1:14455 S ROBERT TRL
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-4932
Practice Address - Country:US
Practice Address - Phone:651-423-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY ORTHODONTIC SPECIALISTS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty