Healthcare Provider Details

I. General information

NPI: 1255758983
Provider Name (Legal Business Name): BRACES R US
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S VAL VISTA DR # 101
MESA AZ
85204-7304
US

IV. Provider business mailing address

1702 S VAL VISTA DR # 101
MESA AZ
85204-7304
US

V. Phone/Fax

Practice location:
  • Phone: 480-668-8200
  • Fax: 480-668-8202
Mailing address:
  • Phone: 480-668-8200
  • Fax: 480-668-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD008176
License Number StateAZ

VIII. Authorized Official

Name: DR. TROY ALAN WILLIAMS
Title or Position: ORTHODONTIST
Credential: DDS, MDS
Phone: 480-668-8200