Provider Demographics
NPI:1760812580
Name:NORWALK ORTHODONTICS ASSOCIATTES
Entity Type:Organization
Organization Name:NORWALK ORTHODONTICS ASSOCIATTES
Other - Org Name:CT BRACES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-374-1911
Mailing Address - Street 1:71 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4903
Mailing Address - Country:US
Mailing Address - Phone:203-866-7608
Mailing Address - Fax:203-683-0524
Practice Address - Street 1:71 EAST AVE STE 2Q
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4903
Practice Address - Country:US
Practice Address - Phone:203-374-1911
Practice Address - Fax:203-683-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty