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General NPI Number Information
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NPI Number | 1114134707
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Entity Type | Individual
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Provider Name | CARLOS BRAVERMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 686 E MAIN ST
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City | TORRINGTON
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State | CT
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Zip | 06790-3931
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Country | US
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Telephone | 860-489-9091
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Fax | 860-496-7110
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Provider Business Mailing Address
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Address Line | 37 SIMSBURY MANOR DR
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City | WEATOGUE
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State | CT
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Zip | 06089-9709
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Country | US
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Telephone | 860-489-9091
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Fax | 860-496-7110
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 008745
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License Number State | CT
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