Individual
JARAD JOSEPH BRADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8747 NORTHWEST DR, SOUTHAVEN, MS 38671-2409
(662) 393-0781
(662) 342-0750
Mailing address
8747 NORTHWEST DR, SOUTHAVEN, MS 38671-2409
(662) 393-0781
(662) 342-0750
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3341-05
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060134
—
MS
Enumeration date
07/20/2006
Last updated
07/08/2007
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