1841316759 NPI number — ORTHODONTIC ASSOCIATES, P.C.

Table of content: MRS. KRISTIN JADE PARADISE OTR (NPI 1851593735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841316759 NPI number — ORTHODONTIC ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHODONTIC ASSOCIATES, P.C.
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:
Provider Other Organization Name Type Code:
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:
1841316759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 S OLD WOODWARD AVE
Provider Second Line Business Mailing Address:
SUITE 605
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-6658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-644-5400
Provider Business Mailing Address Fax Number:
248-644-4954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 S OLD WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 605
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-6658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-644-5400
Provider Business Practice Location Address Fax Number:
248-644-4954
Provider Enumeration Date:
03/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEBECK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
248-644-5400

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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