Provider Demographics
NPI:1740359470
Name:BRAUN, LOIS MAXINE (DDS)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:MAXINE
Last Name:BRAUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 EAST WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-1936
Mailing Address - Country:US
Mailing Address - Phone:319-385-8110
Mailing Address - Fax:
Practice Address - Street 1:307 EAST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1936
Practice Address - Country:US
Practice Address - Phone:319-385-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150979Medicaid