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Organization
BRADEN DENTAL CENTER SC
Active
Organization
BRADEN DENTAL CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK THOMAS BRADEN DDS (OWNER OF BRADEN DENTAL CENTER)
(262) 248-0120
Entity
Organization
Contact information
Practice address
101 BROAD ST, STE 203, LAKE GENEVA, WI 53147
(262) 248-0120
(262) 249-0140
Mailing address
101 BROAD ST, STE 203, LAKE GENEVA, WI 53147
(262) 248-0120
(262) 249-0140
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2499
WI
Other
Enumeration date
05/01/2007
Last updated
09/09/2015
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