MEDICARE: DR. CAROL JEAN BRAUN DDS

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	1223P0221X	Pediatric Dentistry	5950	KY
2	122300000X	Dentist	5950	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4560050900	OTHER	KY	EPSDT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598771750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL JEAN BRAUN DDS

Provider Business Mailing Address
First Line	:	2816 VEACH RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-6295
Country	:	US
Telephone Number	:	270-683-7114
Fax Number	:	270-684-0152

Provider Business Practice Location Address
First Line	:	2816 VEACH RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-6295
Country	:	US
Telephone Number	:	270-683-7114
Fax Number	:	270-684-0152

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/07/2008

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