Provider Demographics
NPI:1891943486
Name:BRAATZ, MONIQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:BRAATZ
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 1:133 JACKSON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9234
Mailing Address - Country:US
Mailing Address - Phone:609-953-4300
Mailing Address - Fax:
Practice Address - Street 1:133 JACKSON RD
Practice Address - Street 2:SUITE E
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9234
Practice Address - Country:US
Practice Address - Phone:609-953-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023793001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice