MEDICARE: DR. PHILLIP MARVIN BRAME SR. DDS MS BOARD CERTIFI

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3987	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659482024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP MARVIN BRAME SR. DDS MS BOARD CERTIFI

Provider Business Mailing Address
First Line	:	PO BOX 1367
Second Line	:	1419 WEST D ST
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-1367
Country	:	US
Telephone Number	:	336-667-1254
Fax Number	:	336-667-1255

Provider Business Practice Location Address
First Line	:	1419 WEST D ST
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-1367
Country	:	US
Telephone Number	:	336-667-1254
Fax Number	:	336-667-1255

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/17/2008

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