Provider Demographics
NPI:1518247949
Name:CT BRACES, LLC
Entity Type:Organization
Organization Name:CT BRACES, LLC
Other - Org Name:STAMFORD ORTHODONTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-374-1911
Mailing Address - Street 1:456 GLENBROOK RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1800
Mailing Address - Country:US
Mailing Address - Phone:203-252-2181
Mailing Address - Fax:
Practice Address - Street 1:456 GLENBROOK RD
Practice Address - Street 2:SUITE #4
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1800
Practice Address - Country:US
Practice Address - Phone:203-252-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty