Provider Demographics
NPI:1386815462
Name:BRAXTON FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:BRAXTON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-775-0870
Mailing Address - Street 1:1154 S BELLEVUE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-3428
Mailing Address - Country:US
Mailing Address - Phone:901-775-0870
Mailing Address - Fax:901-775-0873
Practice Address - Street 1:1154 S BELLEVUE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-3428
Practice Address - Country:US
Practice Address - Phone:901-775-0870
Practice Address - Fax:901-775-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty