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General NPI Number Information
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NPI Number | 1073051413
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Entity Type | Organization
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Legal Business Name | BRAKER LEPD, INC.
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 1139 W BRAKER LANE SUITE 201
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City | AUSTIN
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State | TX
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Zip | 78758
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Country | US
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Telephone | 512-502-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 S. US-183 SUITE 206
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City | LEANDER
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State | TX
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Zip | 78641
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Country | US
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Telephone | 512-817-4940
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Fax | 512-817-4955
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | TARAN BHATIA
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Credential | DMD
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Telephone | 512-817-4940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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