Provider Demographics
NPI:1518480763
Name:BRACES NOW 14, LLC
Entity Type:Organization
Organization Name:BRACES NOW 14, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-287-4051
Mailing Address - Street 1:2371 STRAND AVE
Mailing Address - Street 2:DR BRAD GILBERT
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8204
Mailing Address - Country:US
Mailing Address - Phone:770-287-4051
Mailing Address - Fax:
Practice Address - Street 1:4141 STEVE REYNOLDS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-963-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA127721223X0400X
GAGA147671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty