Provider Demographics
NPI:1114930666
Name:BRAM, EDWARD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:BRAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2233 NESCONSET HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1000
Mailing Address - Country:US
Mailing Address - Phone:631-588-3636
Mailing Address - Fax:631-588-3637
Practice Address - Street 1:2233 NESCONSET HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1000
Practice Address - Country:US
Practice Address - Phone:631-588-3636
Practice Address - Fax:631-588-3637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0284301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice