Provider Demographics
NPI:1083002562
Name:BRAUNLIN AND GLOVER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BRAUNLIN AND GLOVER FAMILY DENTISTRY
Other - Org Name:CHISHOLM TRAIL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRAUNLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-641-2288
Mailing Address - Street 1:403 S COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4618
Mailing Address - Country:US
Mailing Address - Phone:817-641-2288
Mailing Address - Fax:817-641-2426
Practice Address - Street 1:403 S COLONIAL DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4618
Practice Address - Country:US
Practice Address - Phone:817-641-2288
Practice Address - Fax:817-641-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27028122300000X
TX18120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty