Healthcare Provider Details

I. General information

NPI: 1588621163
Provider Name (Legal Business Name): RAYMOND L BRAHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

1635 DIVISADERO ST STE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-8404
  • Fax: 415-514-2561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number50852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: