Active NPI
Stewart Elgen Braddock, DDS
- General Practice Dentistry
- Kirbyville, TX
National Provider Identifier
1578620431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13307
- Practice address
- 2091 South Margaret
Kirbyville, TX 75956 - Phone
- (409) 423-5519
- Fax
- (409) 423-5519
- NPI assigned
- Jan 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13307 | TX | Primary |
Addresses
Primary practice location
2091 South Margaret
Kirbyville, TX 75956
Mailing address
2091 South Margaret
Kirbyville, TX 75956
Phone (409) 423-5519
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 701005 | Other | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13307 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578620431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2091 SOUTH MARGARET",
"city": "KIRBYVILLE",
"state": "TX",
"postal_code": "75956",
"telephone_number": "409-423-5519",
"fax_number": "409-423-5519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2091 SOUTH MARGARET",
"city": "KIRBYVILLE",
"state": "TX",
"postal_code": "75956",
"telephone_number": "409-423-5519",
"fax_number": "409-423-5519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADDOCK",
"first_name": "STEWART",
"middle_name": "ELGEN",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "13307",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "701005",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirbyville, TX
- 409 Therapy Services, PLLC
- Julie Alexander
- Aspire to Be Better Clinic
- Lonnie James Bean Jr., M.D.
- Brookshire Bros Pharmacy of Kirbyville Texas (Brookshire Brothers Pharmacy of Kirbyville)
- Burke Center
- Christus Health Southeast Texas (Christus Southeast Texas Family Practice Center - Kirbyville)
- Cooper and Rosemon L.L.C
- East Texas Family Healthcare PLLC (Family Healthcare- Kirbyville)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.