Provider Demographics
NPI:1881330710
Name:ODIRILE ORTHODONTICS PLLC
Entity type:Organization
Organization Name:ODIRILE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONOLO B.
Authorized Official - Middle Name:
Authorized Official - Last Name:ODIRIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-270-0068
Mailing Address - Street 1:4505 HOLIDAY HILL RD., SUITE 115
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4505 HOLIDAY HILL RD., SUITE 115
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:267-270-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty