Provider Demographics
NPI:1730708561
Name:BRASWELL, JULIANA
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 GORDONHURST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1722
Mailing Address - Country:US
Mailing Address - Phone:973-744-3181
Mailing Address - Fax:
Practice Address - Street 1:177 GORDONHURST AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1722
Practice Address - Country:US
Practice Address - Phone:973-744-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03086400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist