Provider Demographics
NPI:1003624776
Name:DOWNTOWN ORTHO LLC
Entity type:Organization
Organization Name:DOWNTOWN ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDOLFO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-374-5130
Mailing Address - Street 1:14923 PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-1018
Mailing Address - Country:US
Mailing Address - Phone:631-374-5130
Mailing Address - Fax:
Practice Address - Street 1:4951 SEMINOLE PRATT WHITNEY RD
Practice Address - Street 2:SUITE #1100
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-566-7896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOWNTOWN ORTHO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental