Provider Demographics
NPI:1588021778
Name:BRAUTIGAM-MARTINEZ, SILVIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SILVIA
Middle Name:
Last Name:BRAUTIGAM-MARTINEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SILVIA
Other - Middle Name:H
Other - Last Name:BRAUTIGAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:37290 OLD PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3764
Mailing Address - Country:US
Mailing Address - Phone:225-960-5115
Mailing Address - Fax:
Practice Address - Street 1:37290 OLD PERKINS RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3764
Practice Address - Country:US
Practice Address - Phone:225-960-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100125415122300000X
ALD0006482C1122300000X
LA7037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist