# MARTHA JO BRAID DMD LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARTHA JO BRAID DMD LLC
- **Other names:** Dental Care for Kids
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669621140
- **Legal business name:** MARTHA JO BRAID DMD LLC
- **Authorized official:** PAM HARDIEK (INSURANCE/CREDENTIALING)
- **Authorized official phone:** (210) 540-5100

## Contact information

- **Practice address:** 2801-7 CIVIC CIRCLE BLVD, MARION, IL 62959
- **Practice address phone:** (618) 998-9868
- **Practice address fax:** (618) 998-9870
- **Mailing address:** 2801-7 CIVIC CIRCLE BLVD, MARION, IL 62959
- **Mailing address phone:** (618) 998-9868
- **Mailing address fax:** (618) 998-9870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2008
- **Last updated:** 09/09/2008