Provider Demographics
NPI:1700238243
Name:FAST BRACES LLC
Entity Type:Organization
Organization Name:FAST BRACES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEPRIN
Authorized Official - Suffix:
Authorized Official - Credentials:RNMSN
Authorized Official - Phone:937-902-8542
Mailing Address - Street 1:305 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3349
Mailing Address - Country:US
Mailing Address - Phone:614-478-4500
Mailing Address - Fax:
Practice Address - Street 1:4110 BUCKEYE PKWY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8175
Practice Address - Country:US
Practice Address - Phone:614-871-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty