Healthcare Provider Details

I. General information

NPI: 1871085167
Provider Name (Legal Business Name): BRACES FOR U
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9126 TECHNOLOGY LN
FISHERS IN
46038-3064
US

IV. Provider business mailing address

4222 KATTMAN CT
CARMEL IN
46074-1108
US

V. Phone/Fax

Practice location:
  • Phone: 317-797-6688
  • Fax:
Mailing address:
  • Phone: 317-797-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12011584A
License Number StateIN

VIII. Authorized Official

Name: DR. PRITI RANA MAHAJAN
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 317-797-6688