Healthcare Provider Details

I. General information

NPI: 1649515529
Provider Name (Legal Business Name): BRACES R US PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 NORTH ST.
NACOGDOCHES TX
75965
US

IV. Provider business mailing address

4610 NORTH ST.
NACOGDOCHES TX
75965
US

V. Phone/Fax

Practice location:
  • Phone: 936-560-0900
  • Fax:
Mailing address:
  • Phone: 936-560-0900
  • Fax:

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: GUNJAN DHIR
Title or Position: DIRECTOR
Credential: BDS,MS
Phone: 903-723-2130