Healthcare Provider Details

I. General information

NPI: 1104806181
Provider Name (Legal Business Name): CHRISTOPHER JOHN BRAINARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES ROAD CHALMERS P WYLIE VA AMBULATORY CARE CLINIC
COLUMBUS OH
43219
US

IV. Provider business mailing address

420 N JAMES ROAD CHALMERS P WYLIE VA AMBULATORY CARE CLINIC
COLUMBUS OH
43219
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5430
  • Fax:
Mailing address:
  • Phone: 614-257-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.020537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: