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General NPI Number Information
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NPI Number | 1710386933
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Entity Type | Organization
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Legal Business Name | DIAMOND BRACES OF NORWALK CONNECTICUT LLC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 148 EAST AVE SUITE 3H
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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 | 203-857-1717
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Fax | 718-373-6799
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Provider Business Mailing Address
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Address Line | 148 EAST AVE SUITE 3H
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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 | 203-857-1717
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Fax | 718-373-6799
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. OLEG DRUT
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Credential | D.D.S.
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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 | 047218-1
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License Number State | NY
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