Organization
KELLY BRASWELL DDS LLC
Active
Other names
Kelly Braswell DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY W BRASWELL DDS (OWNER DENTIST)
(318) 636-6923
Entity
Organization
Contact information
Practice address
3718 JEWELLA, SHREVEPORT, LA 71109-4704
(318) 636-6923
Mailing address
3718 JEWELLA AVE, SHREVEPORT, LA 71109-4704
(318) 636-6923
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
LA4050
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1840505
—
LA
Enumeration date
05/14/2007
Last updated
08/22/2020
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