Provider Demographics
NPI:1295712834
Name:BRAUN, EDY (DDS)
Entity type:Individual
Prefix:DR
First Name:EDY
Middle Name:
Last Name:BRAUN
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 1:218 LEARNINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6448
Mailing Address - Country:US
Mailing Address - Phone:732-266-6323
Mailing Address - Fax:
Practice Address - Street 1:218 LEARNINGTON WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6448
Practice Address - Country:US
Practice Address - Phone:732-266-6323
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022556001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice