| NPI | 1700091600 |
|---|---|
| Former Legal Business Name | KELLY BRASWELL DDS |
| Entity Type | Organization |
| Authorized Contact | KELLY W BRASWELL Owner Dentist 318-636-6923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA LA4050) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |