Provider Demographics
NPI:1063501815
Name:BRAHIM, JAIME S (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:S
Last Name:BRAHIM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 W BALTIMORE ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1510
Mailing Address - Country:US
Mailing Address - Phone:410-706-6195
Mailing Address - Fax:
Practice Address - Street 1:650 W BALTIMORE ST STE 1401
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1510
Practice Address - Country:US
Practice Address - Phone:410-706-6195
Practice Address - Fax:410-706-4199
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDGA87881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery