Provider Demographics
NPI:1598771750
Name:BRAUN, CAROL JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
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 1:2816 VEACH RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6295
Mailing Address - Country:US
Mailing Address - Phone:270-683-7114
Mailing Address - Fax:270-684-0152
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6295
Practice Address - Country:US
Practice Address - Phone:270-683-7114
Practice Address - Fax:270-684-0152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59501223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4560050900OtherEPSDT
KY60059508Medicaid