Provider Demographics
NPI:1487061214
Name:BRACES BRACES LLC
Entity type:Organization
Organization Name:BRACES BRACES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:HAMIDI
Authorized Official - Last Name:NIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:770-222-2322
Mailing Address - Street 1:150 PROMINENCE POINT PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9108
Mailing Address - Country:US
Mailing Address - Phone:770-479-9999
Mailing Address - Fax:770-479-9990
Practice Address - Street 1:3450 COBB PKWY NW STE 160
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8379
Practice Address - Country:US
Practice Address - Phone:770-222-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRACES BRACES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty