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General NPI Number Information
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NPI Number | 1477896371
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Entity Type | Organization
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Legal Business Name | FACES & BRACES INC
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 301 CITY AVE STE 255
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 610-660-5188
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Fax |
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Provider Business Mailing Address
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Address Line | 301 CITY AVE STE 255
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 610-660-5188
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMEN DHYLLON
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Credential | DDS
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Telephone | 213-631-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS038245
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License Number State | PA
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