Provider Demographics
NPI:1679620975
Name:BRAHEN, ROY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:E
Last Name:BRAHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7538 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3533
Mailing Address - Country:US
Mailing Address - Phone:215-333-4744
Mailing Address - Fax:215-333-5820
Practice Address - Street 1:7538 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3533
Practice Address - Country:US
Practice Address - Phone:215-333-4744
Practice Address - Fax:215-333-5820
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-19904-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist