Provider Demographics
NPI:1689683609
Name:ALLEN S BRAUMILLER JR DDS PC
Entity type:Organization
Organization Name:ALLEN S BRAUMILLER JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRAUMILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:918-486-6516
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429
Mailing Address - Country:US
Mailing Address - Phone:918-486-6516
Mailing Address - Fax:918-486-6517
Practice Address - Street 1:30273 E STATE HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-486-6516
Practice Address - Fax:918-486-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty