Healthcare Provider Details

I. General information

NPI: 1902208739
Provider Name (Legal Business Name): BRACE BUSTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GEIGER RD SUITE B
PHILADELPHIA PA
19115-1009
US

IV. Provider business mailing address

211 GEIGER RD SUITE B
PHILADELPHIA PA
19115-1009
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-0380
  • Fax: 215-969-0215
Mailing address:
  • Phone: 215-677-0380
  • Fax: 215-969-0215

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. JASON BRESLER
Title or Position: OWNER
Credential: DMD
Phone: 215-677-0380