Provider Demographics
NPI:1336763648
Name:BETHLEHEM ORTHODONTICS
Entity Type:Organization
Organization Name:BETHLEHEM ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-995-4032
Mailing Address - Street 1:2340 LOGANVILLE HWY STE A101
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7853
Mailing Address - Country:US
Mailing Address - Phone:770-995-4034
Mailing Address - Fax:770-995-4034
Practice Address - Street 1:426 EXCHANGE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-1791
Practice Address - Country:US
Practice Address - Phone:770-995-4032
Practice Address - Fax:770-995-4034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CC ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental