Provider Demographics
NPI:1992760789
Name:BRAYDICH, RUDOLPH JOHN JR (DDS)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:JOHN
Last Name:BRAYDICH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2160
Mailing Address - Country:US
Mailing Address - Phone:330-534-5408
Mailing Address - Fax:330-534-5490
Practice Address - Street 1:45 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-2160
Practice Address - Country:US
Practice Address - Phone:330-534-5408
Practice Address - Fax:330-534-5490
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300155611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice