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General NPI Number Information
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NPI Number | 1720601099
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Entity Type | Organization
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Legal Business Name | ELIZABETH A F BRAY PLLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 4650 WEDEKIND RD STE 1
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City | SPARKS
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State | NV
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Zip | 89431-7722
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Country | US
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Telephone | 206-818-3297
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 WEDEKIND RD STE 1
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City | SPARKS
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State | NV
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Zip | 89431-7722
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Country | US
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Telephone | 206-818-3297
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Fax |
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Authorized Official
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Title or Position | OFFICER/DENTIST
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Name | DR. ELIZABETH ANNE FASSBURG BRAY
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Credential | DMD
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Telephone | 206-818-3297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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