Charles L Branen, DMD, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7206 Issued in OR

Practice address

4055 Mercantile Dr., Suite 150
Lake Oswego, OR 97035-2633

Phone

(503) 636-3641

Fax

(503) 765-5310

NPI assigned

Jul 14, 2005

Reactivated

Mar 23, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Lake Grove Dental

  • General Practice Dentistry
  • Lake Oswego, OR
  • NPI 1528235314
  NPD

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1639178478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 MERCANTILE DR., SUITE 150",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352633",
            "telephone_number": "503-636-3641",
            "fax_number": "503-765-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 MERCANTILE DR., SUITE 150",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352633",
            "telephone_number": "503-636-3641",
            "fax_number": "503-765-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANEN",
        "first_name": "CHARLES",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD, PC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2023-12-06",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Rodgers Braddock, M.D.
• Shannon Braden, ND
• Jacqueline Bradford, MA, MFT, NCC
• Bradley E Sievert DMD PC
• Nicholas Bradshaw, MT
• Alexi Breazile
• Jessica Nicole Brianza, LMT
• Bridgeworks Oregon
• Stephanie Lynn Britcher, PT
• Barbara Jean Britsch, PA-C

• General Practice Dentistry in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.