Provider Demographics
NPI:1639975774
Name:BRALEY, VICTORIA CORI
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CORI
Last Name:BRALEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEADOW LANE #B1
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468
Mailing Address - Country:US
Mailing Address - Phone:207-290-2063
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND PLACE
Practice Address - Street 2:SUITE 116
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-974-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4611124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist