Provider Demographics
NPI:1558311019
Name:BRAJDIC, DAVID R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:BRAJDIC
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 1:633 WINESAP RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8416
Mailing Address - Country:US
Mailing Address - Phone:540-992-1043
Mailing Address - Fax:
Practice Address - Street 1:5505 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1439
Practice Address - Country:US
Practice Address - Phone:540-366-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist