Provider Demographics
NPI:1174543649
Name:GHRIST ORTHODONTICS, LTD.
Entity type:Organization
Organization Name:GHRIST ORTHODONTICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-377-2847
Mailing Address - Street 1:W65N640 SAINT JOHN AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1924
Mailing Address - Country:US
Mailing Address - Phone:262-377-2847
Mailing Address - Fax:262-377-3806
Practice Address - Street 1:W65N640 SAINT JOHN AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1924
Practice Address - Country:US
Practice Address - Phone:262-377-2847
Practice Address - Fax:262-377-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty