Healthcare Provider Details

I. General information

NPI: 1609088418
Provider Name (Legal Business Name): KEITH M BRAM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 WASHINGTON ST
DOWNERS GROVE IL
60515-4701
US

IV. Provider business mailing address

5145 WASHINGTON ST
DOWNERS GROVE IL
60515-4701
US

V. Phone/Fax

Practice location:
  • Phone: 630-963-9280
  • Fax: 630-964-6980
Mailing address:
  • Phone: 630-963-9280
  • Fax: 630-964-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number028053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: