Provider Demographics
NPI:1912278789
Name:ORTHODONTIC ENTERPRISES, LLC
Entity Type:Organization
Organization Name:ORTHODONTIC ENTERPRISES, LLC
Other - Org Name:CENTER FOR ORTHODONTIC EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:TAMBURRINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-799-4628
Mailing Address - Street 1:61 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1120
Mailing Address - Country:US
Mailing Address - Phone:609-799-4628
Mailing Address - Fax:609-799-4760
Practice Address - Street 1:61 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1120
Practice Address - Country:US
Practice Address - Phone:609-799-4628
Practice Address - Fax:609-799-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02473900261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental