Individual
DR. LARRY A BRAITHWAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1675 NORTH 200 WEST, BLDG 12A, PROVO, UT 84604
(801) 375-4600
(801) 375-4617
Mailing address
1675 NORTH 200 WEST, BLDG 12A, PROVO, UT 84604
(801) 375-4600
(801) 375-4617
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
317547
UT
Other
Enumeration date
08/23/2006
Last updated
07/08/2007
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