Provider Demographics
NPI:1154422590
Name:BRASWELL, DAVID RAY
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 TATUM AVE
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4632
Mailing Address - Country:US
Mailing Address - Phone:662-226-1681
Mailing Address - Fax:662-226-1601
Practice Address - Street 1:347 TATUM AVE
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4632
Practice Address - Country:US
Practice Address - Phone:662-226-1681
Practice Address - Fax:662-226-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2933961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice