Healthcare Provider Details

I. General information

NPI: 1861790461
Provider Name (Legal Business Name): JOSEPH PIERCE BRAUD JR. DDS, MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOE BRAUD

II. Dates (important events)

Enumeration Date: 03/05/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 RUE DE LION
NEW IBERIA LA
70563-2114
US

IV. Provider business mailing address

603 RUE DE LION
NEW IBERIA LA
70563-2114
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-1271
  • Fax:
Mailing address:
  • Phone: 504-333-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6019
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6019
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: