Provider Demographics
NPI:1295183606
Name:BRAUNSTEIN, BLAIR
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 W QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2641
Mailing Address - Country:US
Mailing Address - Phone:716-667-2030
Mailing Address - Fax:716-667-2034
Practice Address - Street 1:6225 W QUAKER ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2641
Practice Address - Country:US
Practice Address - Phone:716-667-2030
Practice Address - Fax:716-667-2034
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0575141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics