Provider Demographics
NPI:1275941494
Name:BRACES AND SMILES PC
Entity Type:Organization
Organization Name:BRACES AND SMILES PC
Other - Org Name:BRACES AND SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:718-268-3666
Mailing Address - Street 1:10850 71ST AVE STE 1G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4524
Mailing Address - Country:US
Mailing Address - Phone:718-268-3666
Mailing Address - Fax:718-268-7785
Practice Address - Street 1:71-06 110TH ST SUITE 1G
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4564
Practice Address - Country:US
Practice Address - Phone:718-268-3666
Practice Address - Fax:718-268-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0571341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty