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NPI Code Detail

MEDICARE: LAURA BRACKEN DDS LLC

MEDICARE: LAURA BRACKEN DDS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1255221545
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAURA BRACKEN DDS LLC
Provider Business Mailing Address
First Line : 2526 CENTRAL AVE
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-3121
Country : US
Telephone Number : 812-373-9912
Fax Number : 812-373-9920
Provider Business Practice Location Address
First Line : 2526 CENTRAL AVE
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-3121
Country : US
Telephone Number : 812-373-9912
Fax Number : 812-373-9920
Authorized Official
Title or Position : OFFICE MANAGER
Name : JERRY M BRACKEN
Credential :
Telephone Number : 812-373-9912
Provider Enumeration Date : 07/08/2025
Last Update Date : 07/08/2025

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Directions to “LAURA BRACKEN DDS LLC ” Practice Location

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