Healthcare Provider Details

I. General information

NPI: 1356254684
Provider Name (Legal Business Name): CLINTON BRACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CENTENNIAL ST STE 312-K
LA PLATA MD
20646-6943
US

IV. Provider business mailing address

6306 KIRBY RD STE 201
CLINTON MD
20735-1336
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-1331
  • Fax: 301-868-5003
Mailing address:
  • Phone: 301-868-1331
  • Fax: 301-868-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRAM NGOC NGUYEN
Title or Position: ORTHODONTIST
Credential:
Phone: 301-868-1331