Provider Demographics
NPI:1194916486
Name:BRADEN, JAYMIE ANN (DDS)
Entity type:Individual
Prefix:MRS
First Name:JAYMIE
Middle Name:ANN
Last Name:BRADEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:JAYMIE
Other - Middle Name:ANN
Other - Last Name:PILCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4371
Mailing Address - Country:US
Mailing Address - Phone:262-723-2900
Mailing Address - Fax:262-723-6360
Practice Address - Street 1:209 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4371
Practice Address - Country:US
Practice Address - Phone:262-723-2900
Practice Address - Fax:262-723-6360
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5913-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
391449280018OtherBLUE CROSS