Provider Demographics
NPI:1386668044
Name:BRAUN, ANDREA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:BRAUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 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:416-730-1315
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329071223G0001X
OR11607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice