Provider Demographics
NPI:1740675081
Name:SIMPLY ORTHODONTICS PC
Entity type:Organization
Organization Name:SIMPLY ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-757-3173
Mailing Address - Street 1:70 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2300
Mailing Address - Country:US
Mailing Address - Phone:508-757-3173
Mailing Address - Fax:
Practice Address - Street 1:24 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-1608
Practice Address - Country:US
Practice Address - Phone:508-757-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0113181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty