Organization
CT BRACES, LLC
Active
Other names
Bridgeport Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHYAM DESAI (MANAGER)
(203) 374-1911
Entity
Organization
Contact information
Practice address
3741 MAIN ST, BRIDGEPORT, CT 06606
(203) 374-1911
Mailing address
3741 MAIN ST, BRIDGEPORT, CT 06606-3609
(203) 374-1911
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922271550
—
CT
Enumeration date
11/29/2010
Last updated
07/22/2011
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