Provider Demographics
NPI:1245716232
Name:TJ ORTHODONTICS
Entity type:Organization
Organization Name:TJ ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMOPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-620-9666
Mailing Address - Street 1:198 THOMAS JOHNSON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4432
Mailing Address - Country:US
Mailing Address - Phone:301-620-9666
Mailing Address - Fax:301-620-9739
Practice Address - Street 1:198 THOMAS JOHNSON DR STE 103
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4432
Practice Address - Country:US
Practice Address - Phone:301-620-9666
Practice Address - Fax:301-620-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty