Provider Demographics
NPI:1801138094
Name:BRAJEVICH, NICHOLAS JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:BRAJEVICH
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 1:23727 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 4 B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5938
Mailing Address - Country:US
Mailing Address - Phone:310-378-1283
Mailing Address - Fax:310-378-3549
Practice Address - Street 1:23727 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 4 B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5938
Practice Address - Country:US
Practice Address - Phone:310-378-1283
Practice Address - Fax:310-378-3549
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist