Provider Demographics
NPI:1871075481
Name:XCELERATED ORTHODONTICS INC
Entity type:Organization
Organization Name:XCELERATED ORTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WONDA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:LEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-610-8255
Mailing Address - Street 1:59 DEER ST UNIT 3B
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3765
Mailing Address - Country:US
Mailing Address - Phone:603-610-8255
Mailing Address - Fax:
Practice Address - Street 1:59 DEER ST UNIT 3B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3765
Practice Address - Country:US
Practice Address - Phone:603-610-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty