Healthcare Provider Details

I. General information

NPI: 1396736278
Provider Name (Legal Business Name): THOMAS W BRAUN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE STREET
PITTSBURGH PA
15261-0001
US

IV. Provider business mailing address

3501 TERRACE STREET
PITTSBURGH PA
15261-0001
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-6802
  • Fax: 412-648-1008
Mailing address:
  • Phone: 412-648-6802
  • Fax: 412-648-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS018159L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: