Provider Demographics
NPI:1396861944
Name:BRADEN, WILLIAM R (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BRADEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CHESTNUT ST
Mailing Address - Street 2:SUITE #36
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3031
Mailing Address - Country:US
Mailing Address - Phone:330-296-9711
Mailing Address - Fax:
Practice Address - Street 1:250 S CHESTNUT ST
Practice Address - Street 2:SUITE #36
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3031
Practice Address - Country:US
Practice Address - Phone:330-296-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH177301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice