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General NPI Number Information
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NPI Number | 1043404536
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Entity Type | Individual
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Provider Name | ELISE R BRAXMEYER DMD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 15125 SW BEARD RD
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City | BEAVERTON
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State | OR
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Zip | 97007-7477
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Country | US
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Telephone | 503-590-4300
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Fax | 503-590-0269
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Provider Business Mailing Address
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Address Line | 15125 SW BEARD RD
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City | BEAVERTON
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State | OR
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Zip | 97007-7477
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Country | US
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Telephone | 503-590-4300
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Fax | 503-590-0269
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D8978
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8978
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License Number State | OR
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