Healthcare Provider Details

I. General information

NPI: 1518398106
Provider Name (Legal Business Name): BRACES OF GREECE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 FETZNER RD.
ROCHESTER NY
14626
US

IV. Provider business mailing address

770 FETZNER RD
ROCHESTER NY
14626-1848
US

V. Phone/Fax

Practice location:
  • Phone: 585-789-1659
  • Fax:
Mailing address:
  • Phone: 585-789-1659
  • Fax: 585-625-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number056408
License Number StateNY

VIII. Authorized Official

Name: DR. ZOHAIR QURESHI
Title or Position: ORTHODONTIST
Credential: DDSMS
Phone: 585-789-1659