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General NPI Number Information
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NPI Number | 1255627915
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Entity Type | Organization
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Legal Business Name | ANTONIO S. BRAITHWAITE DDS MPH PA
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 136 CARBONTON RD
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City | SANFORD
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State | NC
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Zip | 27330-4000
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Country | US
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Telephone | 919-718-5561
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Fax | 919-718-5562
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Provider Business Mailing Address
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Address Line | 136 CARBONTON RD
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City | SANFORD
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State | NC
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Zip | 27330-4000
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Country | US
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Telephone | 919-718-5561
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Fax | 919-718-5562
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Authorized Official
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Title or Position | OWNER/ PEDIATRIC DENTIST
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Name | DR. ANTONIO STANLEY BRAITHWAITE
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Credential | DDS, MPH
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Telephone | 919-260-1154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | NC
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