Braden, Mark Thomas

Braden, Mark Thomas is an individual health care provider with primary practice located at 101 Broad St Suite 203, Lake Geneva WI 53147-2000. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Braden, Mark Thomas can be contacted via phone (262) 248-0120.

Contact Information

Primary practice address
101 Broad St Suite 203 Lake Geneva WI 53147-2000
Phone: (262) 248-0120
Fax: (262) 249-0140
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2499 Wisconsin

Profile Details

NPI number 1780833475
LBN Legal business name Braden, Mark Thomas
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 17th, 2008
Last updated Sep 17th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780833475 NPPES
Wisconsin Other 33418600 MEDICAL ASSISTANT (BADGER CARE, TITLE 19)

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