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General NPI Number Information
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NPI Number | 1235488040
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Entity Type | Organization
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Legal Business Name | JUSTIN BRAGA DDS MS INC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 1844 SAN MIGUEL DR STE 309
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City | WALNUT CREEK
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State | CA
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Zip | 94596-4963
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Country | US
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Telephone | 925-938-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 110 DANVILLA CT
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City | DANVILLE
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State | CA
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Zip | 94526-2402
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Country | US
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Telephone | 415-235-1327
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN BRAGA
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Credential | DDS, MS
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Telephone | 415-235-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 53765
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License Number State | CA
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