Organization
MY ORTHODONTIST
Active
Organization
MY ORTHODONTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RADER (INSURANCE MANAGER)
(215) 946-3655
Entity
Organization
Contact information
Practice address
532 S OXFORD VALLEY RD, FAIRLESS HILLS, PA 19030-2615
(215) 946-0800
Mailing address
532 S OXFORD VALLEY RD, FAIRLESS HILLS, PA 19030-2615
(215) 946-0800
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS018685L
PA
Other
Enumeration date
08/17/2007
Last updated
08/17/2007
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