Provider Demographics
NPI:1649648262
Name:TEMIKO G BRASWELL DDS PC
Entity type:Organization
Organization Name:TEMIKO G BRASWELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMIKO
Authorized Official - Middle Name:GRAVES
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:478-714-2254
Mailing Address - Street 1:1133 MACON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2651
Mailing Address - Country:US
Mailing Address - Phone:478-988-3200
Mailing Address - Fax:478-988-3306
Practice Address - Street 1:1133 MACON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2651
Practice Address - Country:US
Practice Address - Phone:478-988-3200
Practice Address - Fax:478-988-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1093882136122300000X
GA1104963032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty