Provider Demographics
NPI:1245612332
Name:PLAZA ORTHODONTICS
Entity type:Organization
Organization Name:PLAZA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SENTHIL
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:ARUN
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,DMD,MSD, PH D
Authorized Official - Phone:636-232-9933
Mailing Address - Street 1:14560 MANCHESTER RD
Mailing Address - Street 2:STE 24
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3933
Mailing Address - Country:US
Mailing Address - Phone:636-230-9933
Mailing Address - Fax:636-230-8467
Practice Address - Street 1:14560 MANCHESTER RD
Practice Address - Street 2:# 24
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3933
Practice Address - Country:US
Practice Address - Phone:636-230-9933
Practice Address - Fax:636-230-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130094391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty