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General NPI Number Information
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NPI Number | 1063528149
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Entity Type | Organization
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Legal Business Name | THE BRACE PLACE, INC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 EAST AVE
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City | CLERMONT
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State | FL
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Zip | 34711-2534
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Country | US
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Telephone | 352-242-1818
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Fax | 352-242-4835
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Provider Business Mailing Address
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Address Line | 15637 GREATER TRL
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City | CLERMONT
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State | FL
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Zip | 34711-8178
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Country | US
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Telephone | 352-242-1818
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Fax | 352-242-4835
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY MARTIN RUBENSTEIN
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Credential | D.D.S.
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Telephone | 352-242-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5309
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License Number State | FL
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