Provider Demographics
NPI:1073956892
Name:JOHN C BRADEN DDS PC
Entity Type:Organization
Organization Name:JOHN C BRADEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-293-6042
Mailing Address - Street 1:1104 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-1706
Mailing Address - Country:US
Mailing Address - Phone:361-293-6042
Mailing Address - Fax:
Practice Address - Street 1:1104 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-1706
Practice Address - Country:US
Practice Address - Phone:361-293-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty