Provider Demographics
NPI:1902208739
Name:BRACE BUSTERS LLC
Entity Type:Organization
Organization Name:BRACE BUSTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-677-0380
Mailing Address - Street 1:211 GEIGER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1009
Mailing Address - Country:US
Mailing Address - Phone:215-677-0380
Mailing Address - Fax:215-969-0215
Practice Address - Street 1:211 GEIGER RD
Practice Address - Street 2:SUITE B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1009
Practice Address - Country:US
Practice Address - Phone:215-677-0380
Practice Address - Fax:215-969-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029645820001Medicaid