Organization
BRIDGEPORT BRACES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HECTOR PENA (OWNER)
(203) 550-4547
Entity
Organization
Contact information
Practice address
3715 MAIN ST, SUITE 100, BRIDGEPORT, CT 06606-3618
(203) 550-4547
Mailing address
3715 MAIN ST, SUITE 100, BRIDGEPORT, CT 06606-3618
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11343
CT
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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