Organization
BROAD STREET BRACES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL UFFNER D.M.D, M.S. (ORTHODONTIST, OWNDER)
(201) 452-9270
Entity
Organization
Contact information
Practice address
2010 S JUNIPER ST, PHILADELPHIA, PA 19148-5509
(201) 452-9270
Mailing address
2010 S JUNIPER ST, PHILADELPHIA, PA 19148-5509
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS039143
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028648360001
—
PA
Enumeration date
06/06/2016
Last updated
06/06/2016
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