NPIMap

Organization Active NPI

Bridgeport Braces, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bridgeport, CT
National Provider Identifier
1881048080
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
11343 Issued in CT
Legal business name
BRIDGEPORT BRACES, LLC
Practice address
3715 Main St
Suite 100
Bridgeport, CT 06606-3618
Phone
(203) 550-4547
NPI assigned
Apr 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Hector Pena
Title
Owner
Phone
(203) 550-4547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 11343 CT Primary

Addresses

Primary practice location

3715 Main St
Suite 100
Bridgeport, CT 06606-3618

Mailing address

3715 Main St
Suite 100
Bridgeport, CT 06606-3618

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1881048080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 MAIN ST",
            "address_2": "SUITE 100",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066063618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 MAIN ST",
            "address_2": "SUITE 100",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066063618",
            "telephone_number": "203-550-4547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT BRACES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-550-4547",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "11343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.