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General NPI Number Information
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NPI Number | 1447765417
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Entity Type | Organization
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Legal Business Name | BRAVMAN ORAL SURGERY, LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 68 CAMP STREET
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City | HYANNIS
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State | MA
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Zip | 02061
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Country | US
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Telephone | 508-771-6665
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Fax | 508-790-4119
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Provider Business Mailing Address
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Address Line | 68 CAMP STREET
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City | HYANNIS
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State | MA
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Zip | 02061
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Country | US
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Telephone | 508-771-6665
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Fax | 508-790-4119
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD J BRAVMAN
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Credential | DMD, MS
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Telephone | 508-771-6665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 14452
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License Number State | MA
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