Provider Demographics
NPI:1457410482
Name:BRAVELAND FAMILY DENTAL PA
Entity Type:Organization
Organization Name:BRAVELAND FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHLAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-895-0300
Mailing Address - Street 1:2500 COUNTY ROAD 42 W
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6945
Mailing Address - Country:US
Mailing Address - Phone:952-895-0300
Mailing Address - Fax:
Practice Address - Street 1:2500 COUNTY ROAD 42 W
Practice Address - Street 2:SUITE 8
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6945
Practice Address - Country:US
Practice Address - Phone:952-895-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty