Provider Demographics
NPI:1679505200
Name:BRAUD, JOHN P JR (DDS, M ED)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BRAUD
Suffix:JR
Gender:M
Credentials:DDS, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31620 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1819
Mailing Address - Country:US
Mailing Address - Phone:734-261-7800
Mailing Address - Fax:734-261-8484
Practice Address - Street 1:31620 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1819
Practice Address - Country:US
Practice Address - Phone:734-261-7800
Practice Address - Fax:734-261-8484
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29010178141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics