Provider Demographics
NPI:1336703057
Name:BRACES BY ABBADENT, LLC
Entity Type:Organization
Organization Name:BRACES BY ABBADENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-556-8388
Mailing Address - Street 1:3430 DODGE ST.
Mailing Address - Street 2:SUITE 19
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003
Mailing Address - Country:US
Mailing Address - Phone:563-580-2564
Mailing Address - Fax:
Practice Address - Street 1:3430 DODGE ST.
Practice Address - Street 2:SUITE 19
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003
Practice Address - Country:US
Practice Address - Phone:563-580-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty