Provider Demographics
NPI:1821188053
Name:THE ORTHODONTIC GROUP PA
Entity Type:Organization
Organization Name:THE ORTHODONTIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAZMIERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-596-1933
Mailing Address - Street 1:64 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2141
Mailing Address - Country:US
Mailing Address - Phone:856-596-1933
Mailing Address - Fax:856-596-4001
Practice Address - Street 1:64 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2141
Practice Address - Country:US
Practice Address - Phone:856-596-1933
Practice Address - Fax:856-596-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty