Provider Demographics
NPI:1184251068
Name:BRAZILE, BRIANA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:BRAZILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9326 BROKEN PINE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3157
Mailing Address - Country:US
Mailing Address - Phone:704-728-9608
Mailing Address - Fax:
Practice Address - Street 1:8700 PINEVILLE MATTHEWS RD STE 920
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4748
Practice Address - Country:US
Practice Address - Phone:704-336-9595
Practice Address - Fax:704-336-9587
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNNA1223G0001X
NC12152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice