Healthcare Provider Details

I. General information

NPI: 1013945476
Provider Name (Legal Business Name): CHARLES RICHARD BRAGA D.M.D., M.M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BAY RD
NEWMARKET NH
03857-1740
US

IV. Provider business mailing address

211 BAY RD
NEWMARKET NH
03857-1740
US

V. Phone/Fax

Practice location:
  • Phone: 603-661-6368
  • Fax: 801-729-1621
Mailing address:
  • Phone: 603-661-6368
  • Fax: 801-729-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number18388
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3018
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: