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General NPI Number Information
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NPI Number | 1144229709
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Entity Type | Individual
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Provider Name | EARL BRADEN GARD IV D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2005
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Last Update Date | 04/24/2016
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Provider Practice Location Address
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Address Line | 55 S VALLE VERDE DR STE. 250
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City | HENDERSON
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State | NV
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Zip | 89012-3433
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Country | US
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Telephone | 702-260-1890
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Fax | 702-260-7936
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Provider Business Mailing Address
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Address Line | 1103 SAN GABRIEL AVE
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City | HENDERSON
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State | NV
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Zip | 89002-9433
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Country | US
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Telephone | 702-566-1278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5523
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5736
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License Number State | NV
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