Provider Demographics
NPI:1851790109
Name:BRACES BRACES BRACES OF STONEHAVEN- LEHI LLC
Entity Type:Organization
Organization Name:BRACES BRACES BRACES OF STONEHAVEN- LEHI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8501
Mailing Address - Street 1:181 N 1200 E
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2224
Mailing Address - Country:US
Mailing Address - Phone:801-766-3600
Mailing Address - Fax:801-812-8459
Practice Address - Street 1:181 N 1200 E
Practice Address - Street 2:SUITE B
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2224
Practice Address - Country:US
Practice Address - Phone:801-766-3600
Practice Address - Fax:801-812-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty