Healthcare Provider Details

I. General information

NPI: 1417932831
Provider Name (Legal Business Name): GARY A BRAUN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD NORTH SUITE 2419
LAS VEGAS NV
89191-6601
US

IV. Provider business mailing address

7733 VILLA DEL FUEGO AVE
LAS VEGAS NV
89131-1670
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2643
  • Fax: 702-653-2682
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI01124700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: