Jack L Brauer, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47988549921 Issued in UT

Practice address

450 Bern Way
Midway, UT 84049

Phone

(619) 840-7080

NPI assigned

Jan 15, 2010

Last updated

May 20, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: records@precision-mobile.direct.consensus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Precision Dentures, LLC

  dba Precision Mobile Care

  • Dentist
  • Park City, UT
  • NPI 1508297342
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1407187362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 BERN WAY",
            "city": "MIDWAY",
            "state": "UT",
            "postal_code": "84049",
            "telephone_number": "619-840-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BERN WAY",
            "city": "MIDWAY",
            "state": "UT",
            "postal_code": "84049",
            "telephone_number": "619-840-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUER",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-15",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "47988549921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407187362",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "records@precision-mobile.direct.consensus.com",
            "affiliation": "Y",
            "affiliationName": "Precision Dentures, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1401 Moray Ct",
            "city": "Park City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840606947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Cascade Academy
• Neil Drew Christensen, M.D.
• ZD Chudyba, MSOM, LICENSED ACUPU

• General Practice Dentistry in Midway, UT
• Providers in Midway, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.