Individual
DR. JACK L BRAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
450 BERN WAY, MIDWAY, UT 84049
(619) 840-7080
Mailing address
450 BERN WAY, MIDWAY, UT 84049
(619) 840-7080
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
47988549921
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407187362
—
UT
Enumeration date
01/15/2010
Last updated
05/20/2022
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