Provider Demographics
NPI:1225241730
Name:C.JEFFERY BRADDY,DDS
Entity Type:Organization
Organization Name:C.JEFFERY BRADDY,DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:BRADDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-883-9300
Mailing Address - Street 1:404 LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4879
Mailing Address - Country:US
Mailing Address - Phone:336-883-9300
Mailing Address - Fax:336-883-6668
Practice Address - Street 1:404 LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4879
Practice Address - Country:US
Practice Address - Phone:336-883-9300
Practice Address - Fax:336-883-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990969Medicaid
NC8990969Medicaid