Healthcare Provider Details

I. General information

NPI: 1184044604
Provider Name (Legal Business Name): BRAYDICH DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E LIBERTY ST
HUBBARD OH
44425-2160
US

IV. Provider business mailing address

45 E LIBERTY ST
HUBBARD OH
44425-2160
US

V. Phone/Fax

Practice location:
  • Phone: 330-534-5408
  • Fax: 330-534-5490
Mailing address:
  • Phone: 330-534-5408
  • Fax: 330-534-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: RUDOLPH JOHN BRAYDICH JR.
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 330-651-3554