Provider Demographics
NPI:1598353161
Name:BRATTLE STREET ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:BRATTLE STREET ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEDKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-441-5437
Mailing Address - Street 1:575 MOUNT AUBURN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4627
Mailing Address - Country:US
Mailing Address - Phone:617-441-5437
Mailing Address - Fax:
Practice Address - Street 1:575 MOUNT AUBURN ST STE 202
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4627
Practice Address - Country:US
Practice Address - Phone:617-441-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty