Provider Demographics
NPI:1083676415
Name:BRASHER, RICHARD R JR (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:BRASHER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 METRO DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3451
Mailing Address - Country:US
Mailing Address - Phone:318-445-5471
Mailing Address - Fax:318-445-5901
Practice Address - Street 1:1400 METRO DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3451
Practice Address - Country:US
Practice Address - Phone:318-445-5471
Practice Address - Fax:318-445-5901
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry