Healthcare Provider Details

I. General information

NPI: 1134231509
Provider Name (Legal Business Name): BRAFMAN FAMILY DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31383 DOGWOOD ACRES RD UNIT 2
DAGSBORO DE
19939
US

IV. Provider business mailing address

31383 DOGWOOD ACRES RD UNIT 2
DAGSBORO DE
19939
US

V. Phone/Fax

Practice location:
  • Phone: 302-732-3852
  • Fax: 302-732-3855
Mailing address:
  • Phone: 302-732-3852
  • Fax: 302-732-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1102
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1125
License Number StateDE

VIII. Authorized Official

Name: WENDY WILSON BRAFMAN
Title or Position: DENTIST
Credential: DDS
Phone: 302-732-3852