Provider Demographics
NPI:1528042801
Name:FRANKLIN, BRAD ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ANTHONY
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-8003
Mailing Address - Country:US
Mailing Address - Phone:601-879-0031
Mailing Address - Fax:601-879-8474
Practice Address - Street 1:106 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-8003
Practice Address - Country:US
Practice Address - Phone:601-879-0031
Practice Address - Fax:601-879-0091
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3294-041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice