Healthcare Provider Details

I. General information

NPI: 1114589017
Provider Name (Legal Business Name): MAX BRAUN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 STILLSON RD STE 12
FAIRFIELD CT
06824-3158
US

IV. Provider business mailing address

427 STILLSON RD STE 12
FAIRFIELD CT
06824-3158
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-0512
  • Fax:
Mailing address:
  • Phone: 203-374-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12613
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: