Provider Demographics
NPI:1881152577
Name:CTOR ORTHODONTICS
Entity type:Organization
Organization Name:CTOR ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:551-225-1915
Mailing Address - Street 1:129 WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4650
Mailing Address - Country:US
Mailing Address - Phone:551-225-1915
Mailing Address - Fax:551-225-1918
Practice Address - Street 1:129 WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4650
Practice Address - Country:US
Practice Address - Phone:551-225-1915
Practice Address - Fax:551-225-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0662071Medicaid