Provider Demographics
NPI:1114613338
Name:ROSEBURG FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:ROSEBURG FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-673-0131
Mailing Address - Street 1:1729 W HARVARD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2795
Mailing Address - Country:US
Mailing Address - Phone:541-673-0131
Mailing Address - Fax:541-673-0176
Practice Address - Street 1:1729 W HARVARD AVE STE 1
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2795
Practice Address - Country:US
Practice Address - Phone:541-673-0131
Practice Address - Fax:541-673-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental