Healthcare Provider Details

I. General information

NPI: 1922303668
Provider Name (Legal Business Name): LAWRENCE BRACES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 ESSEX ST
LAWRENCE MA
01840-1410
US

IV. Provider business mailing address

355 ESSEX ST
LAWRENCE MA
01840-1410
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-0000
  • Fax: 508-306-4333
Mailing address:
  • Phone: 978-794-0000
  • Fax: 508-306-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20511
License Number StateMA

VIII. Authorized Official

Name: DR. HOUSSAM ALKHOURY
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-589-8270