MEDICARE: BRAMWELL DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336524636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAMWELL DENTISTRY

Provider Business Mailing Address
First Line	:	9221 E BASELINE RD
Second Line	:	#111
City	:	MESA
State	:	AZ
Zip	:	85209-8310
Country	:	US
Telephone Number	:	480-357-7759
Fax Number	:	480-422-7391

Provider Business Practice Location Address
First Line	:	9221 E BASELINE RD
Second Line	:	111
City	:	MESA
State	:	AZ
Zip	:	85209-8310
Country	:	US
Telephone Number	:	480-357-7759
Fax Number	:	480-422-7391

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT SPENCER BRAMWELL
Credential	:	DDS
Telephone Number	:	480-357-7759

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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