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General NPI Number Information
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NPI Number | 1699487371
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Entity Type | Organization
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Legal Business Name | CLINTON BRACES
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1345 GOOD HOPE RD SE
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City | WASHINGTON
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State | DC
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Zip | 20020-6909
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Country | US
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Telephone | 301-868-1331
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Fax | 301-868-5003
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Provider Business Mailing Address
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Address Line | 6306 KIRBY RD
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City | CLINTON
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State | MD
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Zip | 20735-1336
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Country | US
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Telephone | 301-868-1331
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Fax | 301-868-5003
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Authorized Official
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Title or Position | PROVIDER
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Name | TRAM NGOC NGUYEN
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Credential | DDS
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Telephone | 301-868-1331
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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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