Provider Demographics
NPI:1588353247
Name:CORNERSTONE BRACES, INC.
Entity type:Organization
Organization Name:CORNERSTONE BRACES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE JERYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MDS, MS
Authorized Official - Phone:214-729-0426
Mailing Address - Street 1:180 S COLLINS RD., #200
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182
Mailing Address - Country:US
Mailing Address - Phone:214-663-9144
Mailing Address - Fax:
Practice Address - Street 1:180 S COLLINS RD., #200
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182
Practice Address - Country:US
Practice Address - Phone:214-663-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty