Provider Demographics
NPI:1669814455
Name:BRAAKSMA, CHRISTABELLE E (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTABELLE
Middle Name:E
Last Name:BRAAKSMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHRISTABELLE
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1916
Practice Address - Country:US
Practice Address - Phone:608-443-5482
Practice Address - Fax:608-443-5534
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029549122300000X
WI1001037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist