Provider Demographics
NPI:1134231509
Name:BRAFMAN FAMILY DENTISTRY PA
Entity type:Organization
Organization Name:BRAFMAN FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BRAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-732-3852
Mailing Address - Street 1:31383 DOGWOOD ACRES RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939
Mailing Address - Country:US
Mailing Address - Phone:302-732-3852
Mailing Address - Fax:302-732-3855
Practice Address - Street 1:31383 DOGWOOD ACRES RD
Practice Address - Street 2:UNIT 2
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939
Practice Address - Country:US
Practice Address - Phone:302-732-3852
Practice Address - Fax:302-732-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG11021223G0001X
DEG11251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001026908Medicaid
DE0001166931Medicaid