Provider Demographics
NPI:1326043704
Name:BRAVERMAN, BRUCE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOXCHASE RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3437
Mailing Address - Country:US
Mailing Address - Phone:610-647-7969
Mailing Address - Fax:
Practice Address - Street 1:3500 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1017
Practice Address - Country:US
Practice Address - Phone:610-384-1467
Practice Address - Fax:610-384-1492
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0191871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice