Myorthos Connecticut Orthodontics PC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

MYORTHOS CONNECTICUT ORTHODONTICS PC

Practice address

2 Daniels Farm Road
Units NN25-26
Trumbull, CT 06611

Phone

(203) 590-3222

Fax

(203) 590-3273

NPI assigned

Jan 31, 2024

Organization subpart

Yes

Parent organization

MYORTHOS CONNECTICUT ORTHODONTICS PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Casey Lonabocker

Title

VP Operations & Strategy

Phone

(617) 535-3364

Specialties & licenses 1

Addresses

Other names 1

• Orthodontic Boutique Doing business as

Tax ID family

Myorthos Connecticut Orthodontics PC5 organizations share this tax ID, including this one

Part of

Myorthos Connecticut Orthodontics PC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Myorthos Connecticut Orthodontics PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Waterford, CT
  • NPI 1235899816
  NPD tax ID
• Myorthos Connecticut Orthodontics PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bridgeport, CT
  • NPI 1316571425
  NPD tax ID
• Myorthos Connecticut Orthodontics, P.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Newtown, CT
  • NPI 1417628397
  NPD tax ID
• Myorthos Connecticut Orthodontics PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Boston, MA
  • NPI 1518558907
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1124881537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 MONROE TPKE STE K",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066111300",
            "telephone_number": "203-590-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DANIELS FARM ROAD",
            "address_2": "UNITS NN25-26",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "06611",
            "telephone_number": "203-590-3222",
            "fax_number": "203-590-3273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Old Kings Hwy S Ste 101",
            "address_purpose": "LOCATION",
            "city": "Darien",
            "state": "CT",
            "postal_code": "068204537",
            "country_code": "US",
            "telephone_number": "203-590-6776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MYORTHOS CONNECTICUT ORTHODONTICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYORTHOS CONNECTICUT ORTHODONTICS PC",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "LONABOCKER",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "VP OPERATIONS & STRATEGY",
        "authorized_official_telephone_number": "617-535-3364"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthodontic Boutique",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthodontic Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Trumbull, CT
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.