1962842070 NPI number — ORTHODONTIQUE

Table of content: THERESA CYR ATC, LAT (NPI 1467049783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962842070 NPI number — ORTHODONTIQUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHODONTIQUE
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:
1962842070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-823-0847
Provider Business Mailing Address Fax Number:
724-823-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-823-0847
Provider Business Practice Location Address Fax Number:
724-823-0853
Provider Enumeration Date:
07/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RINCUSE
Authorized Official First Name:
DARA
Authorized Official Middle Name:
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
724-823-0847

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  DS037494 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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