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General NPI Number Information
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NPI Number | 1265889570
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Entity Type | Organization
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Legal Business Name | DARCHELLE BRAXTON DMD PC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 4300 POUNCEY TRACT ROAD SUITE I
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City | GLEN ALLEN
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State | VA
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Zip | 23060
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Country | US
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Telephone | 804-709-8166
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 POUNCEY TRACT ROAD SUITE I
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City | GLEN ALLEN
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State | VA
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Zip | 23060
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Country | US
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Telephone | 804-709-8166
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. DARCHELLE BRAXTON
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Credential | DMD
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Telephone | 804-709-8166
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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 | 0401414243
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License Number State | VA
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