Provider Demographics
NPI:1801043138
Name:BRAMBILA, CARMEN D (DMD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:D
Last Name:BRAMBILA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0609
Mailing Address - Country:US
Mailing Address - Phone:781-899-7070
Mailing Address - Fax:781-899-1802
Practice Address - Street 1:695 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0609
Practice Address - Country:US
Practice Address - Phone:781-899-7070
Practice Address - Fax:781-899-1802
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856140122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110098455AMedicaid