Provider Demographics
NPI:1881084747
Name:EZZYBRACES LLC
Entity type:Organization
Organization Name:EZZYBRACES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHYLLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-876-3300
Mailing Address - Street 1:130 E BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2310
Mailing Address - Country:US
Mailing Address - Phone:610-876-3300
Mailing Address - Fax:610-876-2042
Practice Address - Street 1:130 E BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2310
Practice Address - Country:US
Practice Address - Phone:610-876-3300
Practice Address - Fax:610-876-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty