Provider Demographics
NPI:1093093312
Name:ATKINS, BRADEN CORDELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:CORDELL
Last Name:ATKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W 1825 N
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3148
Mailing Address - Country:US
Mailing Address - Phone:801-201-7429
Mailing Address - Fax:
Practice Address - Street 1:4645 S 4000 W STE B
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-6250
Practice Address - Country:US
Practice Address - Phone:216-264-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9017911-99241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics