1427151026 NPI number — ORTHODONTICS OF LAKEWOOD RANCH LLP

Table of content: (NPI 1427151026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427151026 NPI number — ORTHODONTICS OF LAKEWOOD RANCH LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHODONTICS OF LAKEWOOD RANCH LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MORICZ AND VARONE ORTHODONTICS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427151026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6286 LAKE OSPREY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34240-8425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-907-8898
Provider Business Mailing Address Fax Number:
941-907-2244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6286 LAKE OSPREY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34240-8425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-907-8898
Provider Business Practice Location Address Fax Number:
941-907-2244
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
D'ANGELO
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
94190708898

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  DN16869 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: DN16195 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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