Basic Information
| Provider Information | |||||||||
| NPI: | 1861650004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAVERMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2107 E WALNUT AVE. | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064280235 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2107 E WALNUT AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307214552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064280235 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 10878 | GA | Y | Dental Providers | Dentist | General Practice |
No ID Information.