Healthcare Provider Details

I. General information

NPI: 1386668044
Provider Name (Legal Business Name): ANDREA S. BRAUN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 W HARVARD AVE STE 1
ROSEBURG OR
97471-2795
US

IV. Provider business mailing address

1729 W HARVARD AVE STE 1
ROSEBURG OR
97471-2795
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-0131
  • Fax: 541-673-0176
Mailing address:
  • Phone: 416-730-1315
  • Fax: 541-673-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32907
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11607
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: