Provider Demographics
NPI:1154489490
Name:BRASSELL, DAVID LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:BRASSELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1383 MANCHESTER DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3882
Mailing Address - Country:US
Mailing Address - Phone:770-922-6149
Mailing Address - Fax:770-922-6680
Practice Address - Street 1:1383 MANCHESTER DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3882
Practice Address - Country:US
Practice Address - Phone:770-922-6149
Practice Address - Fax:770-922-6680
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0122261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice