Provider Demographics
NPI:1588007140
Name:BRACETOWN ORTHODONTICS,LLP
Entity type:Organization
Organization Name:BRACETOWN ORTHODONTICS,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-721-5100
Mailing Address - Street 1:3119 NEWTOWN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1350
Mailing Address - Country:US
Mailing Address - Phone:718-721-5100
Mailing Address - Fax:
Practice Address - Street 1:3119 NEWTOWN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1350
Practice Address - Country:US
Practice Address - Phone:718-721-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-14
Last Update Date:2013-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty