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General NPI Number Information
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NPI Number | 1598128886
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Entity Type | Individual
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Provider Name | ALYSSA BRAILSFORD DDS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 115 WOODGREEN XING
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City | MADISON
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State | MS
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Zip | 39110-4522
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Country | US
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Telephone | 601-664-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MARK SMITH DR
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City | MANDEVILLE
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State | LA
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Zip | 70471-5300
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Country | US
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Telephone | 985-788-8621
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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 | 6665
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License Number State | LA
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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 | 4155
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4241
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License Number State | MS
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