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General NPI Number Information
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NPI Number | 1710375498
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Entity Type | Organization
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Legal Business Name | DIAMOND BRACES OF NORWALK
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 15 ENGLE ST SUITE 303
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2936
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Country | US
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Telephone | 201-308-8181
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Fax | 201-875-5588
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Provider Business Mailing Address
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Address Line | 148 EAST AVE
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City | NORWALK
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State | CT
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Zip | 06851-5721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLEG DRUT
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Credential | DDS
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Telephone | 203-857-1717
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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 | 11275
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License Number State | CT
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