Provider Demographics
NPI:1699487371
Name:CLINTON BRACES
Entity type:Organization
Organization Name:CLINTON BRACES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TRAM
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-868-1331
Mailing Address - Street 1:6306 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1336
Mailing Address - Country:US
Mailing Address - Phone:301-868-1331
Mailing Address - Fax:301-868-5003
Practice Address - Street 1:1345 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6909
Practice Address - Country:US
Practice Address - Phone:301-868-1331
Practice Address - Fax:301-868-5003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON BRACES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty