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General NPI Number Information
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NPI Number | 1750050159
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Entity Type | Organization
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Legal Business Name | PASCAGOULA FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 3613-A HOSPITAL RD
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City | PASCAGOULA
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State | MS
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Zip | 39581
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Country | US
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Telephone | 228-769-1244
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Fax |
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Provider Business Mailing Address
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Address Line | 139 S MAIN ST
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City | PETAL
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State | MS
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Zip | 39465-2331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOBBY GLENN BRASWELL JR.
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Credential | DDS
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Telephone | 601-584-9481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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