Provider Demographics
NPI:1366528671
Name:BRACY, DEWEY L (DMD)
Entity type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:L
Last Name:BRACY
Suffix:
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 1:7755 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1234
Mailing Address - Country:US
Mailing Address - Phone:727-343-0824
Mailing Address - Fax:727-343-0927
Practice Address - Street 1:7755 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1234
Practice Address - Country:US
Practice Address - Phone:727-343-0824
Practice Address - Fax:727-343-0927
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 10883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist