Healthcare Provider Details

I. General information

NPI: 1588684054
Provider Name (Legal Business Name): THOMAS F BRAUN, D. M. D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 STILLSON RD STE 12
FAIRFIELD CT
06824
US

IV. Provider business mailing address

427 STILLSON RD STE 12
FAIRFIELD CT
06824
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 Number5825
License Number StateCT

VIII. Authorized Official

Name: DR. THOMAS BRAUN
Title or Position: OWNER
Credential: D. M. D.
Phone: 203-374-0512