Provider Demographics
NPI:1962007393
Name:OLDHAM FAMILY ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:OLDHAM FAMILY ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-256-7886
Mailing Address - Street 1:115 KOHLERS XING STE 350
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2467
Mailing Address - Country:US
Mailing Address - Phone:512-256-7886
Mailing Address - Fax:
Practice Address - Street 1:115 KOHLERS XING STE 350
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2467
Practice Address - Country:US
Practice Address - Phone:512-256-7886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty