Individual provider Active NPI

Brian Bruce Brailsford, DDS

  • Dentist
  • Chattanooga, TN
National Provider Identifier
1114542602
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12068 Issued in TN
Practice address
7741 E Brainerd Rd
Chattanooga, TN 37421-5902
Phone
(423) 523-0861
NPI assigned
Jun 10, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4644 AR
Dentist 122300000X 7056 LA
Dentist 122300000X 12068 TN Primary

Addresses

Primary practice location

7741 E Brainerd Rd
Chattanooga, TN 37421-5902

Mailing address

1809 Henegar Cir
Chattanooga, TN 37421-5778
Phone (985) 789-3205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210121001158 LA Order and Referring Only - DentistPractitioner - Dentist 2466866132

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12068TNMDPharmacist
4644ARMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1114542602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 HENEGAR CIR",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374215778",
            "telephone_number": "985-789-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7741 E BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374215902",
            "telephone_number": "423-523-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAILSFORD",
        "first_name": "BRIAN",
        "middle_name": "BRUCE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "4644",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "7056",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "12068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.