1477947786 NPI number — PRESTON ORTHODONTICS, PLLC

Table of content: (NPI 1477947786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477947786 NPI number — PRESTON ORTHODONTICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESTON ORTHODONTICS, PLLC
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:
1477947786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2154 FAIRPORT NINE MILE POINT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-880-5520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2154 FAIRPORT NINE MILE POINT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-880-5520
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PRESTON
Authorized Official First Name:
JANIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ORTHODONTIST/OWNER
Authorized Official Telephone Number:
585-880-5520

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  052380-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1669698593 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com