Provider Demographics
NPI:1124681903
Name:BRAASCH DENTISTRY 2
Entity type:Organization
Organization Name:BRAASCH DENTISTRY 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-745-3182
Mailing Address - Street 1:12200 E ILIFF AVE
Mailing Address - Street 2:BLDG C, STE 104
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-745-3182
Mailing Address - Fax:303-766-0817
Practice Address - Street 1:12200 E ILIFF AVE
Practice Address - Street 2:BLDG C, STE 104
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-745-3182
Practice Address - Fax:303-766-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental