Organization
BLUE JACKETS BRACES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN DEAN (ADMINISTRATOR)
(614) 706-5206
Entity
Organization
Contact information
Practice address
1175 COLUMBUS PIKE, DELAWARE, OH 43015-2713
(740) 293-0178
Mailing address
1175 COLUMBUS PIKE, DELAWARE, OH 43015-2713
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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