Provider Demographics
NPI:1053739292
Name:ADVANCED ORTHODONTICS,LLC
Entity type:Organization
Organization Name:ADVANCED ORTHODONTICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:UTTAMPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-916-8564
Mailing Address - Street 1:12333 83RD AVE
Mailing Address - Street 2:APT#206
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3421
Mailing Address - Country:US
Mailing Address - Phone:801-916-8564
Mailing Address - Fax:
Practice Address - Street 1:182 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1534
Practice Address - Country:US
Practice Address - Phone:860-928-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0106721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty