Provider Demographics
NPI:1730219346
Name:BRATMAN, GARY BRUCE (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRUCE
Last Name:BRATMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 SANTA MONICA BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-6403
Mailing Address - Country:US
Mailing Address - Phone:310-839-2722
Mailing Address - Fax:310-839-2022
Practice Address - Street 1:10231 SANTA MONICA BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-6403
Practice Address - Country:US
Practice Address - Phone:310-839-2722
Practice Address - Fax:310-839-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice