Bobby Glenn Braswell Jr., DDS

Key facts

NPI

1295949386

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

3411-07 (MS)

Practice address

139 S Main St
Petal, MS 39465

Phone

(601) 584-9481

Fax

(601) 544-5161

NPI assigned

May 9, 2007

Sex

Male

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Quentin N Burdick Comprehensive Health Care Facility Rural Acute Care Hospital · Belcourt, ND · NPI 1952346934
  Medicare reassignment NPD TX
• Pascagoula Family Dentistry, LLC General Practice Dentistry · Pascagoula, MS · NPI 1750050159
  NPD Authorized official GENERAL PRACTICE
• Petal Family Dentistry General Practice Dentistry · Petal, MS · NPI 1972908622
  NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2014.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1295949386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 S MAIN ST",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "39465",
            "telephone_number": "601-584-9481",
            "fax_number": "601-544-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 S MAIN ST",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "39465",
            "telephone_number": "601-584-9481",
            "fax_number": "601-544-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRASWELL",
        "first_name": "BOBBY",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3411-07",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID#",
            "identifier": "12264946",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petal, MS

• Lawrence C Bender III, PHARMD
• Alisa Berteau, PHARM D, FDN
• Sarah Elise Blackledge, DPT
• Dee C Blackwell, O.D.
• Allison Joy Boutwell, PA-C
• Trish Anne Brix-Baskin, LCSW
• Lauren Brown
• Ronald A Bullock, MD
• Tammy Bullock, RPH
• John Paul Bumgardner, PT

All providers in Petal, MS · General Practice Dentistry in Mississippi