Healthcare Provider Details

I. General information

NPI: 1770215980
Provider Name (Legal Business Name): BRADEN S PUTICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SOUTHERN JUNCTION BLVD STE 701
POOLER GA
31322-2216
US

IV. Provider business mailing address

48 SWAMP WHITE OAK DR
BLUFFTON SC
29910-4418
US

V. Phone/Fax

Practice location:
  • Phone: 912-330-4545
  • Fax:
Mailing address:
  • Phone: 843-384-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: