Provider Demographics
NPI:1184044604
Name:BRAYDICH DENTAL INC
Entity Type:Organization
Organization Name:BRAYDICH DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRAYDICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-651-3554
Mailing Address - Street 1:45 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2160
Mailing Address - Country:US
Mailing Address - Phone:330-534-5408
Mailing Address - Fax:330-534-5490
Practice Address - Street 1:45 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-2160
Practice Address - Country:US
Practice Address - Phone:330-534-5408
Practice Address - Fax:330-534-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment