Provider Demographics
NPI:1114542602
Name:BRAILSFORD, BRIAN BRUCE (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:BRUCE
Last Name:BRAILSFORD
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 HENEGAR CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5778
Mailing Address - Country:US
Mailing Address - Phone:985-789-3205
Mailing Address - Fax:
Practice Address - Street 1:7741 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5902
Practice Address - Country:US
Practice Address - Phone:423-523-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4644122300000X
LA7056122300000X
TN12068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist