Provider Demographics
NPI:1124673959
Name:BRACHOWICZ DENTAL
Entity type:Organization
Organization Name:BRACHOWICZ DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERILYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-484-1760
Mailing Address - Street 1:75 TRAPELO RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4448
Mailing Address - Country:US
Mailing Address - Phone:617-484-1760
Mailing Address - Fax:
Practice Address - Street 1:75 TRAPELO RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4448
Practice Address - Country:US
Practice Address - Phone:617-484-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental