Provider Demographics
NPI:1104806181
Name:BRAINARD, CHRISTOPHER JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:BRAINARD
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 1:420 N JAMES ROAD
Mailing Address - Street 2:CHALMERS P WYLIE VA AMBULATORY CARE CLINIC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:614-257-5430
Mailing Address - Fax:
Practice Address - Street 1:420 N JAMES ROAD
Practice Address - Street 2:CHALMERS P WYLIE VA AMBULATORY CARE CLINIC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-257-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0205371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice