Healthcare Provider Details

I. General information

NPI: 1629121637
Provider Name (Legal Business Name): GREG BRAUNSTEIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD SUITE B-110
STUART FL
34994-2471
US

IV. Provider business mailing address

900 SE OCEAN BLVD SUITE B-110
STUART FL
34994-2471
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-3000
  • Fax: 772-283-2211
Mailing address:
  • Phone: 772-286-3000
  • Fax: 772-283-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: