Individual
BRADEN JAMES NICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5920 N MAY AVE, OKLAHOMA CITY, OK 73112-4277
(405) 494-4961
Mailing address
2721 NW 172ND ST, EDMOND, OK 73012-7000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7790
OK
Other
Enumeration date
06/22/2023
Last updated
06/22/2023
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