Mark Thomas Braden, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2499 Issued in WI

Practice address

101 Broad St
Suite 203
Lake Geneva, WI 53147-2000

Phone

(262) 248-0120

Fax

(262) 249-0140

NPI assigned

Sep 17, 2008

Last updated

Sep 17, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mark Thomas Braden Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Braden Dental Center SC

  • Dental Clinic/Center
  • Lake Geneva, WI
  • NPI 1679793632
  Authorized official Same address or phone

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221609600000",
    "number": "1780833475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BROAD ST",
            "address_2": "SUITE 203",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472000",
            "telephone_number": "262-248-0120",
            "fax_number": "262-249-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BROAD ST",
            "address_2": "SUITE 203",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472000",
            "telephone_number": "262-248-0120",
            "fax_number": "262-249-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADEN",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-17",
        "last_updated": "2008-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANT (BADGER CARE, TITLE 19)",
            "identifier": "33418600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "BRADEN",
            "middle_name": "THOMAS",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ashley E. Boro, OT
• Kenneth B. Bortin, MD
• Susan Lynn Bosman, OTR
• Braden Dental Center SC
• Amanda J Braden, OTR/L
• Ryan Thomas Braden
• Joseph S Brantman, M.D.
• Brenda Brauer
• Bridgelight Counseling (Christina Dame DBA Bridgelight Counseling)
• Bridgelight Counseling (Christina Dame DBA Bridgelight Counseling)

• General Practice Dentistry in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; 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.