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General NPI Number Information
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NPI Number | 1861647588
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Entity Type | Organization
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Legal Business Name | NATHAN BRAVERMAN DMD MD PC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 1770 FIRST ST. 350
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3200
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Country | US
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Telephone | 847-433-1516
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Fax | 847-433-1548
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Provider Business Mailing Address
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Address Line | 1770 1ST ST SUITE 350
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3200
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Country | US
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Telephone | 847-433-1516
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Fax | 847-433-1548
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. NATHAN ALAN BRAVERMAN
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Credential | DMD, MD
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Telephone | 847-433-1516
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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 | 019023544
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License Number State | IL
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