Provider Demographics
NPI:1811495211
Name:ANDERSON & BRAULT, PLLC
Entity type:Organization
Organization Name:ANDERSON & BRAULT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LE ANN
Authorized Official - Middle Name:BAXTER
Authorized Official - Last Name:WINIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-577-1153
Mailing Address - Street 1:409 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-1117
Mailing Address - Country:US
Mailing Address - Phone:360-577-1153
Mailing Address - Fax:360-425-1540
Practice Address - Street 1:409 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-1117
Practice Address - Country:US
Practice Address - Phone:360-577-1153
Practice Address - Fax:360-425-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty