Provider Demographics
NPI:1326664103
Name:BRAUCHLA, TAYLOR NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:NICOLE
Last Name:BRAUCHLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:NICOLE
Other - Last Name:SHIREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:241 DEPOT CIR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8302
Mailing Address - Country:US
Mailing Address - Phone:317-213-5575
Mailing Address - Fax:
Practice Address - Street 1:2545 CAPITAL AVE SW STE 210
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7103
Practice Address - Country:US
Practice Address - Phone:269-841-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016005231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice