Provider Demographics
NPI:1457936163
Name:JFK ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:JFK ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-948-6787
Mailing Address - Street 1:7140 N DURANGO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4473
Mailing Address - Country:US
Mailing Address - Phone:702-740-8437
Mailing Address - Fax:
Practice Address - Street 1:7140 N DURANGO DR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4473
Practice Address - Country:US
Practice Address - Phone:702-740-8437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty