Provider Demographics
NPI:1154406668
Name:BRACKETT, JOHN HENRY JR (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:BRACKETT
Suffix:JR
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 1:25771 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561
Mailing Address - Country:US
Mailing Address - Phone:251-981-2273
Mailing Address - Fax:251-981-2132
Practice Address - Street 1:25771 CANAL RD
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561
Practice Address - Country:US
Practice Address - Phone:251-981-2273
Practice Address - Fax:251-981-2132
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAGD700021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice