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General NPI Number Information
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NPI Number | 1770215980
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Entity Type | Individual
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Provider Name | BRADEN S PUTICH DDS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 125 SOUTHERN JUNCTION BLVD STE 701
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City | POOLER
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State | GA
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Zip | 31322-2216
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Country | US
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Telephone | 912-330-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 48 SWAMP WHITE OAK DR
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City | BLUFFTON
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State | SC
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Zip | 29910-4418
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Country | US
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Telephone | 843-384-8796
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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 | DN122729
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License Number State | GA
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