Healthcare Provider Details

I. General information

NPI: 1912002213
Provider Name (Legal Business Name): MICHELLE ROWE BRAMMER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9360 CEDAR CENTER WAY
LOUISVILLE KY
40291-4522
US

IV. Provider business mailing address

9360 CEDAR CENTER WAY
LOUISVILLE KY
40291-4522
US

V. Phone/Fax

Practice location:
  • Phone: 502-239-9070
  • Fax: 502-239-9078
Mailing address:
  • Phone: 502-239-9070
  • Fax: 502-239-9078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8352
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: