Provider Demographics
NPI:1487681128
Name:BRADDY, CLAUDE JEFFERY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:JEFFERY
Last Name:BRADDY
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 1:404 LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4830
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:27262-4830
Practice Address - Country:US
Practice Address - Phone:336-883-9300
Practice Address - Fax:336-883-6668
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990969Medicaid
NCU41091Medicare UPIN