Provider Demographics
NPI:1306682356
Name:BRATHWAITE, ADRIANNE NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:NICOLE
Last Name:BRATHWAITE
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 1:2616 CEDAR TREE RD APT A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7801 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2411
Practice Address - Country:US
Practice Address - Phone:405-691-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT79471223P0221X, 1223P0300X, 1223S0112X, 1223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223P0300XDental ProvidersDentistPeriodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics