Provider Demographics
NPI:1922816107
Name:PURE ORTHODONTICS PC
Entity type:Organization
Organization Name:PURE ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-966-6300
Mailing Address - Street 1:1929 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3810
Mailing Address - Country:US
Mailing Address - Phone:347-966-6300
Mailing Address - Fax:
Practice Address - Street 1:1929 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3810
Practice Address - Country:US
Practice Address - Phone:347-966-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty