Organization
ORTHODONTIC PROFESSIONAL SERVICES
Active
Other names
ION Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCELA MATAMOROS DMD (PRESIDENT)
(772) 528-3434
Entity
Organization
Contact information
Practice address
1813 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5544
(772) 528-3434
Mailing address
1813 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5544
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN20300
FL
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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