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NPI Code Detail

MEDICARE: BRAXTON FAMILY DENTISTRY LLC

MEDICARE: BRAXTON FAMILY DENTISTRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry7160TN

General Provider Information

NPI Number : 1386815462
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRAXTON FAMILY DENTISTRY LLC
Provider Business Mailing Address
First Line : 1154 S BELLEVUE BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38106-3428
Country : US
Telephone Number : 901-775-0870
Fax Number : 901-775-0873
Provider Business Practice Location Address
First Line : 1154 S BELLEVUE BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38106-3428
Country : US
Telephone Number : 901-775-0870
Fax Number : 901-775-0873
Authorized Official
Title or Position : DENTIST
Name : DR. SONIA DENISE BRAXTON
Credential : DDS
Telephone Number : 901-775-0870
Provider Enumeration Date : 03/17/2008
Last Update Date : 03/17/2008

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Directions to “BRAXTON FAMILY DENTISTRY LLC ” Practice Location

Language Start Address Practice Location
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