Provider Demographics
NPI:1598128886
Name:BRAILSFORD, ALYSSA (DDS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BRAILSFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MARK SMITH DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-5300
Mailing Address - Country:US
Mailing Address - Phone:985-788-8621
Mailing Address - Fax:
Practice Address - Street 1:115 WOODGREEN XING
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-4522
Practice Address - Country:US
Practice Address - Phone:601-664-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6665122300000X
AR4155122300000X
MS42411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist