Provider Demographics
NPI:1255979563
Name:MBRACE ORTHODONTICS PLLC
Entity type:Organization
Organization Name:MBRACE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-699-4160
Mailing Address - Street 1:74 GRAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2062
Mailing Address - Country:US
Mailing Address - Phone:207-699-4160
Mailing Address - Fax:
Practice Address - Street 1:74 GRAY RD STE 1
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2062
Practice Address - Country:US
Practice Address - Phone:207-699-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental