NPIMap

Organization Active NPI

Tag Orthodontics PLLC

Doing business as Paciorek Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Camillus, NY
National Provider Identifier
1316725096
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
TAG ORTHODONTICS PLLC
Doing business as
Paciorek Orthodontics
Practice address
4981 W Genesee St
Camillus, NY 13031-2313
Phone
(315) 487-3335
NPI assigned
Sep 15, 2023
Last updated
Sep 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
TAG ORTHODONTICS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

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

Authorized official

Name
Stacy Pope
Title
Project Manager
Phone
(616) 737-9401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X Primary

Addresses

Primary practice location

4981 W Genesee St
Camillus, NY 13031-2313

Mailing address

5300 Patterson Ave SE Ste 110
Grand Rapids, MI 49512-9758
Phone (616) 283-8867

Other names 1

  • Paciorek Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tag Orthodontics PLLC3 organizations share this tax ID, including this one
Part of
Tag Orthodontics PLLC

Other organizations with this tax ID 2

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

Locations

4981 W Genesee St
Camillus, NY 13031
Phone (315) 487-3335

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1316725096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 PATTERSON AVE SE STE 110",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495129758",
            "telephone_number": "616-283-8867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4981 W GENESEE ST",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312313",
            "telephone_number": "315-487-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAG ORTHODONTICS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TAG ORTHODONTICS PLLC",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A",
        "authorized_official_last_name": "POPE",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "PROJECT MANAGER",
        "authorized_official_telephone_number": "616-737-9401"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paciorek Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camillus, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.