Organization
BRACE YOURSELF ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
(941) 955-3150
Entity
Organization
Contact information
Practice address
16329 STATE ROAD 23, SOUTH BEND, IN 46635-1457
(574) 243-8843
Mailing address
16329 STATE ROAD 23, SOUTH BEND, IN 46635-1457
(574) 243-8843
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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