Healthcare Provider Details

I. General information

NPI: 1225629108
Provider Name (Legal Business Name): CAMPUS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 08/05/2024
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5294 PARK AVE
BRIDGEPORT CT
06604-1018
US

IV. Provider business mailing address

5294 PARK AVE
BRIDGEPORT CT
06604-1018
US

V. Phone/Fax

Practice location:
  • Phone: 203-212-3200
  • Fax: 203-372-0280
Mailing address:
  • Phone: 203-212-3200
  • Fax: 203-372-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THOMAS F BRAUN
Title or Position: OWNER
Credential: DMD
Phone: 203-685-8217