Provider Demographics
NPI:1942515473
Name:BRAXMEYER, NATHAN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
Last Name:BRAXMEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1605
Mailing Address - Country:US
Mailing Address - Phone:503-873-8614
Mailing Address - Fax:503-873-6020
Practice Address - Street 1:303 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1605
Practice Address - Country:US
Practice Address - Phone:503-873-8614
Practice Address - Fax:503-873-6020
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice