Provider Demographics
NPI:1497317648
Name:BRADEN, CHARELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARELLE
Middle Name:
Last Name:BRADEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 SUNSET CLIFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3849
Mailing Address - Country:US
Mailing Address - Phone:619-224-2210
Mailing Address - Fax:
Practice Address - Street 1:1499 SUNSET CLIFFS BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3849
Practice Address - Country:US
Practice Address - Phone:619-224-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice