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Contact Information

JACK L BRAUER, DDS
450 BERN WAY
MIDWAY, UT84049
 Phone: 619-840-7080
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for JACK L BRAUER · (Male)

NPI Number 1407187362
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 01/15/2010
Last updated 05/20/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • UT License # 47988549921
  • UT Medicaid 1407187362
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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