Provider Demographics
NPI:1841976800
Name:MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Entity type:Organization
Organization Name:MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS & STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONABOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-535-3364
Mailing Address - Street 1:4771 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-2012
Mailing Address - Country:US
Mailing Address - Phone:724-327-9193
Mailing Address - Fax:
Practice Address - Street 1:4771 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-2012
Practice Address - Country:US
Practice Address - Phone:724-327-9193
Practice Address - Fax:724-733-5265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYORTHOS PENNSYLVANIA ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty