Provider Demographics
NPI:1700174216
Name:BRAUNECK, DANIEL THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:BRAUNECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3935
Mailing Address - Country:US
Mailing Address - Phone:386-328-9206
Mailing Address - Fax:
Practice Address - Street 1:120 S HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3935
Practice Address - Country:US
Practice Address - Phone:386-328-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 194231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice