Provider Demographics
NPI:1922755677
Name:REDEMPTION ORTHODONTICS
Entity Type:Organization
Organization Name:REDEMPTION ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:VRACAR
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-457-0566
Mailing Address - Street 1:2213 GREYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-6004
Mailing Address - Country:US
Mailing Address - Phone:386-457-0566
Mailing Address - Fax:
Practice Address - Street 1:1614 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5324
Practice Address - Country:US
Practice Address - Phone:850-782-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty