Provider Demographics
NPI:1518402262
Name:MILFORD BRACES PC
Entity Type:Organization
Organization Name:MILFORD BRACES PC
Other - Org Name:SIMPLY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-505-5040
Mailing Address - Street 1:403 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1349
Mailing Address - Country:US
Mailing Address - Phone:508-429-7800
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:#101
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2634
Practice Address - Country:US
Practice Address - Phone:508-473-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN205111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty