Provider Demographics
NPI:1891925343
Name:BRASWELL, MELISSA (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BARTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44075 N GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1312
Mailing Address - Country:US
Mailing Address - Phone:586-463-8383
Mailing Address - Fax:
Practice Address - Street 1:44075 N GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1312
Practice Address - Country:US
Practice Address - Phone:586-463-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist