Provider Demographics
NPI:1205274586
Name:BRAITHWAITE, AARON M (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:M
Last Name:BRAITHWAITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FARABEE DR N STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5915
Mailing Address - Country:US
Mailing Address - Phone:765-447-7200
Mailing Address - Fax:765-449-1333
Practice Address - Street 1:103 FARABEE DR N STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5915
Practice Address - Country:US
Practice Address - Phone:765-447-7200
Practice Address - Fax:765-449-1333
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011982A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist