Provider Demographics
NPI:1619970159
Name:BRAZA, JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:BRAZA
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 1:1804 SAVIERS RD
Mailing Address - Street 2:STE B
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3649
Mailing Address - Country:US
Mailing Address - Phone:805-385-4888
Mailing Address - Fax:805-385-4889
Practice Address - Street 1:1804 SAVIERS RD
Practice Address - Street 2:STE B
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3649
Practice Address - Country:US
Practice Address - Phone:805-385-4888
Practice Address - Fax:805-385-4889
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-28
Last Update Date:2007-07-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CA461691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA246169OtherDELTA DENTAL OF CA
CAB46169Medicaid