MEDICARE: DR. GARY A BRAUN DMD

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	1223P0700X	Prosthodontics	22DI01124700	NJ

General Provider Information

NPI Number	:	1417932831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY A BRAUN DMD

Provider Business Mailing Address
First Line	:	7733 VILLA DEL FUEGO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 LAS VEGAS BLVD NORTH
Second Line	:	SUITE 2419
City	:	LAS VEGAS
State	:	NV
Zip	:	89191-6601
Country	:	US
Telephone Number	:	702-653-2643
Fax Number	:	702-653-2682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/08/2007

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