Individual
DR. DANIEL BRADDOCK LA GRUA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1557 COMMERCE RD, SUITE 204, VERONA, VA 24482-9703
(540) 248-2500
(540) 248-2526
Mailing address
116 W HILL FARM DR, STAUNTON, VA 24401-5463
(540) 885-0720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10544
DELTA DENTAL OF VA
VA
01
—
1376320
UNITED CONCORDIA
—
01
—
237197
ANTHEM BC/BS
VA
Enumeration date
04/13/2006
Last updated
07/08/2007
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