Individual
DR. BOBBY GLENN BRASWELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
139 S MAIN ST, PETAL, MS 39465
(601) 584-9481
(601) 544-5161
Mailing address
139 S MAIN ST, PETAL, MS 39465
(601) 584-9481
(601) 544-5161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3411-07
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12264946
CAQH ID#
MS
Enumeration date
05/09/2007
Last updated
10/17/2014
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