Provider Demographics
NPI:1740741073
Name:BRACES PLUS PC
Entity Type:Organization
Organization Name:BRACES PLUS PC
Other - Org Name:CONNOR DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:A C
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:340-776-0030
Mailing Address - Street 1:1916 NINTH ST
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2640
Mailing Address - Country:US
Mailing Address - Phone:340-776-0030
Mailing Address - Fax:340-774-9760
Practice Address - Street 1:1916 NINTH ST
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2640
Practice Address - Country:US
Practice Address - Phone:340-776-0030
Practice Address - Fax:340-774-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1477742237Medicaid