Provider Demographics
NPI:1770012452
Name:BRACE, ELISE (DMD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BRACE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 W OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9472
Mailing Address - Country:US
Mailing Address - Phone:910-512-7685
Mailing Address - Fax:
Practice Address - Street 1:9776 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-7620
Practice Address - Country:US
Practice Address - Phone:919-863-3933
Practice Address - Fax:919-863-3935
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice