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General NPI Number Information
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NPI Number | 1811011455
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Entity Type | Organization
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Legal Business Name | NICHOLAS J. BRAJEVICH, D.D.S. INCORPORATED
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 23727 HAWTHORNE BLVD SUITE 4B
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City | TORRANCE
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State | CA
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Zip | 90505-5938
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Country | US
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Telephone | 310-378-1283
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Fax | 310-378-3549
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Provider Business Mailing Address
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Address Line | 23727 HAWTHORNE BLVD SUITE 4B
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City | TORRANCE
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State | CA
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Zip | 90505-5938
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Country | US
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Telephone | 310-378-1283
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Fax | 310-378-3549
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. NICHOLAS JOHN BRAJEVICH
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Credential | D.D.S.
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Telephone | 310-378-1283
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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 | 41064
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License Number State | CA
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