Healthcare Provider Details

I. General information

NPI: 1679505200
Provider Name (Legal Business Name): JOHN P BRAUD JR. DDS, M. ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31620 SCHOOLCRAFT RD
LIVONIA MI
48150-1819
US

IV. Provider business mailing address

31620 SCHOOLCRAFT RD
LIVONIA MI
48150-1819
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-7800
  • Fax: 734-261-8484
Mailing address:
  • Phone: 734-261-7800
  • Fax: 734-261-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901017814
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: