Active NPI
Eric Joseph Braum, DMD
- Student in an Organized Health Care Education/Training Program
- Watertown, WI
National Provider Identifier
1750138202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1149 Boughton St BLDG B
Watertown, WI 53094-3104 - Phone
- (920) 261-0495
- NPI assigned
- May 2, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 60015200-15 | WI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1149 Boughton St BLDG B
Watertown, WI 53094-3104
Mailing address
7926 30TH Ave
Kenosha, WI 53142-4612
Phone (262) 705-7967
Other practice location 1
846 E Reinel St
Jefferson, WI 53549-9443
Phone (920) 674-6714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60015200-15 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717200000000",
"number": "1750138202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7926 30TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531424612",
"telephone_number": "262-705-7967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1149 BOUGHTON ST BLDG B",
"city": "WATERTOWN",
"state": "WI",
"postal_code": "530943104",
"telephone_number": "920-261-0495"
}
],
"practiceLocations": [
{
"address_1": "846 E Reinel St",
"address_purpose": "LOCATION",
"city": "Jefferson",
"state": "WI",
"postal_code": "535499443",
"country_code": "US",
"telephone_number": "920-674-6714",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRAUM",
"first_name": "ERIC",
"middle_name": "JOSEPH",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-02",
"last_updated": "2024-06-01",
"certification_date": "2024-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "60015200-15",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.