Healthcare Provider Details

I. General information

NPI: 1730106188
Provider Name (Legal Business Name): ALLEN S BRAUMILLER JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30273 E STATE HWY 51
COWETA OK
74429
US

IV. Provider business mailing address

PO BOX 158
COWETA OK
74429
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-6516
  • Fax: 918-486-6517
Mailing address:
  • Phone: 918-486-6516
  • Fax: 918-486-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4509
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: