NPIMap

Organization Active NPI

Ezzybraces LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Brookhaven, PA
National Provider Identifier
1881084747
Registry record updated Jan 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DS038245 Issued in PA
Legal business name
EZZYBRACES LLC
Practice address
130 E Brookhaven Rd
Brookhaven, PA 19015-2310
Phone
(610) 876-3300
Fax
(610) 876-2042
NPI assigned
Jan 30, 2015
Last updated
Jan 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2015

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

Authorized official

Name
Dr. Amen Dhyllon
Title
Member
Phone
(610) 876-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DS038245 PA Primary

Addresses

Primary practice location

130 E Brookhaven Rd
Brookhaven, PA 19015-2310

Mailing address

130 E Brookhaven Rd
Brookhaven, PA 19015-2310
Phone (610) 876-3300

National Provider Directory

National Provider Directory

Locations

130 E Brookhaven Rd
Brookhaven, PA 19015
Phone (610) 876-3300

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422662400000",
    "number": "1881084747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E BROOKHAVEN RD",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152310",
            "telephone_number": "610-876-3300",
            "fax_number": "610-876-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E BROOKHAVEN RD",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152310",
            "telephone_number": "610-876-3300",
            "fax_number": "610-876-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EZZYBRACES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-01-31",
        "status": "A",
        "authorized_official_last_name": "DHYLLON",
        "authorized_official_first_name": "AMEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "610-876-3300",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "DS038245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookhaven, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2015; 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.