Provider Demographics
NPI:1245321918
Name:BRAM, GARY M (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:BRAM
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 1:3534 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1737
Mailing Address - Country:US
Mailing Address - Phone:718-229-3232
Mailing Address - Fax:718-229-5655
Practice Address - Street 1:3534 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1737
Practice Address - Country:US
Practice Address - Phone:718-229-3232
Practice Address - Fax:718-229-5655
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice