Provider Demographics
NPI:1104963032
Name:BRASWELL, TEMIKO GRAVES (DDS)
Entity type:Individual
Prefix:DR
First Name:TEMIKO
Middle Name:GRAVES
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 MACON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2651
Mailing Address - Country:US
Mailing Address - Phone:478-988-3200
Mailing Address - Fax:478-988-3306
Practice Address - Street 1:1133 MACON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2651
Practice Address - Country:US
Practice Address - Phone:478-988-3200
Practice Address - Fax:478-988-3306
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1517848OtherUNITED CONCORDIA
GA00954687-BMedicaid
GA100713OtherAVESIS