Provider Demographics
NPI:1851740534
Name:ORTHODONTIC CARE OF CAROLINA, PA
Entity Type:Organization
Organization Name:ORTHODONTIC CARE OF CAROLINA, PA
Other - Org Name:ORTHOCARE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FORD
Authorized Official - Middle Name:SAWYER
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-576-2828
Mailing Address - Street 1:3850 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1752
Mailing Address - Country:US
Mailing Address - Phone:864-576-2828
Mailing Address - Fax:864-576-2864
Practice Address - Street 1:3850 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1752
Practice Address - Country:US
Practice Address - Phone:864-576-2828
Practice Address - Fax:864-576-2864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC CARE OF CAROLINA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty