Provider Demographics
NPI:1699704403
Name:BRAZONES, MARGARET M (DDS, MS)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:BRAZONES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S US HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8783
Mailing Address - Country:US
Mailing Address - Phone:231-347-4049
Mailing Address - Fax:231-347-4822
Practice Address - Street 1:1601 S US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8783
Practice Address - Country:US
Practice Address - Phone:231-347-4049
Practice Address - Fax:231-347-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI140291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2771500Medicaid