Provider Demographics
NPI:1902661325
Name:3D DENTAL & ORTHODOTICS LLC
Entity Type:Organization
Organization Name:3D DENTAL & ORTHODOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABD
Authorized Official - Middle Name:AL HADI
Authorized Official - Last Name:KAWAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-434-9908
Mailing Address - Street 1:340 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6306
Mailing Address - Country:US
Mailing Address - Phone:469-434-9908
Mailing Address - Fax:
Practice Address - Street 1:340 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6306
Practice Address - Country:US
Practice Address - Phone:469-434-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No122300000XDental ProvidersDentistGroup - Single Specialty