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General NPI Number Information
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NPI Number | 1497474134
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Entity Type | Organization
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Legal Business Name | BRACE CENTRAL DDS PC
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 2468 CONEY ISLAND AVE STE 2L
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City | BROOKLYN
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State | NY
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Zip | 11223-5022
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Country | US
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Telephone | 718-998-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 224 RICHARDS LN
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City | HEWLETT
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State | NY
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Zip | 11557-2630
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Country | US
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Telephone | 718-998-1888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. POLINA INGBERMAN
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Credential | DDS
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Telephone | 646-734-0004
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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 |
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License Number State |
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