Organization
CT BRACES BRIDGEPORT ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHYAM DESAI D.M.D (OWNER/ORTHODONTIST)
(203) 374-1911
Entity
Organization
Contact information
Practice address
3909 MAIN ST, SUITE A, BRIDGEPORT, CT 06606-2872
(203) 374-1911
(203) 683-0524
Mailing address
3909 MAIN ST, SUITE A, BRIDGEPORT, CT 06606-2872
(203) 374-1911
(203) 683-0524
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
009802
CT
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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