Organization
BRACES ONE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANG PHAM (MANAGER)
(646) 400-3630
Entity
Organization
Contact information
Practice address
1598 MARION MOUNT GILEAD RD, MARION, OH 43302-5820
(740) 386-6600
Mailing address
1598 MARION MOUNT GILEAD RD, MARION, OH 43302-5820
(740) 386-6600
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30-022960
OH
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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