Northshore Orthodontics, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

6567 Issued in LA

Legal business name

NORTHSHORE ORTHODONTICS, LLC

Practice address

4010 Lonesome Rd
Mandeville, LA 70448-7085

Phone

(985) 626-0160

Fax

(985) 727-4459

NPI assigned

Jul 12, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rebecca Payne, DDS, MSNPI 1447794490

Title

Owner

Phone

(985) 626-0160

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Rebecca Payne, DDS, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Mandeville, LA
  • NPI 1447794490
  NPD (past) Authorized official
• Ronald A Madere, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Mandeville, LA
  • NPI 1386727980
  NPD (past)

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1659893550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 LONESOME RD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704487085",
            "telephone_number": "985-626-0160",
            "fax_number": "985-727-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 LONESOME RD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704487085",
            "telephone_number": "985-626-0160",
            "fax_number": "985-727-4459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 Georgia Ave",
            "address_purpose": "LOCATION",
            "city": "Bogalusa",
            "state": "LA",
            "postal_code": "704273825",
            "country_code": "US",
            "telephone_number": "985-626-0160",
            "fax_number": "985-727-4459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHSHORE ORTHODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-626-0160",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "LA",
            "license": "6567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.