Provider Demographics
NPI:1831406230
Name:ORENCO ORTHODONTICS LLC
Entity type:Organization
Organization Name:ORENCO ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:503-924-2248
Mailing Address - Street 1:5625 NE ELAM YOUNG PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6422
Mailing Address - Country:US
Mailing Address - Phone:503-924-2248
Mailing Address - Fax:503-924-2241
Practice Address - Street 1:5625 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6422
Practice Address - Country:US
Practice Address - Phone:503-924-2248
Practice Address - Fax:503-924-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty