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NPI Code Detail

MEDICARE: BRACES4KIDS, PLLC

MEDICARE: BRACES4KIDS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1447633953
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRACES4KIDS, PLLC
Provider Business Mailing Address
First Line : 601 28 1/4 RD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-6022
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1022 LIBERTY LN
Second Line :
City : PUEBLO
State : CO
Zip : 81001-2039
Country : US
Telephone Number : 970-523-6333
Fax Number :
Authorized Official
Title or Position : INSURANCE COORDINATOR
Name : TONJA CRONKHITE
Credential :
Telephone Number : 970-523-6333
Provider Enumeration Date : 07/01/2015
Last Update Date : 07/01/2015

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