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General NPI Number Information
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NPI Number | 1831762863
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Entity Type | Individual
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Provider Name | DR. JESSICA BRAGG
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 2328 S 4TH ST
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City | CHICKASHA
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State | OK
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Zip | 73018-6804
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Country | US
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Telephone | 214-729-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 823 N FM 548 STE 130
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City | FORNEY
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State | TX
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Zip | 75126-7142
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Country | US
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Telephone | 214-729-0800
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37419
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License Number State | TX
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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 | 7518
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License Number State | OK
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