Provider Demographics
NPI:1144466517
Name:ADVANCED ORTHODONTICS
Entity type:Organization
Organization Name:ADVANCED ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROSNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:571-248-0300
Mailing Address - Street 1:5321 MERCHANTS VIEW SQ
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-5436
Mailing Address - Country:US
Mailing Address - Phone:571-248-0300
Mailing Address - Fax:571-248-0301
Practice Address - Street 1:5321 MERCHANTS VIEW SQ
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-5436
Practice Address - Country:US
Practice Address - Phone:571-248-0300
Practice Address - Fax:571-248-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071881223X0400X
VA04010066741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty