Provider Demographics
NPI:1811073125
Name:DEWEY L. BRACY, DMD, PA
Entity type:Organization
Organization Name:DEWEY L. BRACY, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-343-0824
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty