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General NPI Number Information
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NPI Number | 1336570654
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Entity Type | Organization
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Legal Business Name | R. B. BRAIDFOOT DMD PLLC
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 7777 FOREST LN C-626
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 672-566-6383
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Fax | 972-566-3847
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN C-626
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 672-566-6383
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Fax | 972-566-3847
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Authorized Official
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Title or Position | PEDIATRIC DENTIST, OWNE/OPERATOR
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Name | DR. RAYMOND BLAKE BRAIDFOOT
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Credential | DMD
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Telephone | 972-566-6383
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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 | 23666
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License Number State | TX
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