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General NPI Number Information
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NPI Number | 1992293443
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Entity Type | Organization
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Legal Business Name | BRACES ON ME, P.C.
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 209 BOSTON POST RD STE 312
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City | MILFORD
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State | CT
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Zip | 06460-3161
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Country | US
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Telephone | 203-876-9965
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Fax | 203-876-9972
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Provider Business Mailing Address
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Address Line | 209 BOSTON POST RD STE 312
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City | MILFORD
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State | CT
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Zip | 06460-3161
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Country | US
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Telephone | 203-876-9965
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Fax | 203-876-9972
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JESUS A VILLEGAS
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Credential | DDS
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Telephone | 203-876-9965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8668
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License Number State | CT
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