Kelly Braswell DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

License

LA4050 Issued in LA

Legal business name

KELLY BRASWELL DDS LLC

Practice address

3718 Jewella
Shreveport, LA 71109-4704

Phone

(318) 636-6923

NPI assigned

May 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kelly W Braswell, DDS

Title

Owner Dentist

Phone

(318) 636-6923

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelly Braswell DDS Former legal business name

Locations

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700091600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3718 JEWELLA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711094704",
            "telephone_number": "318-636-6923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3718 JEWELLA",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711094704",
            "telephone_number": "318-636-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY BRASWELL DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRASWELL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "318-636-6923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "LA4050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1840505",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly Braswell DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Shirley A Kelley, CRNA
• Tamra Kelley
• Kristi Lee Kellogg, PTA
• Lisa Nicole Kellogg, CRNA
• Marsha Kellum
• Kelly Eye Care, L.L.C.
• Kelly Optometry, a Professional Corporation
• Brittany Elaine Kelly, PA
• Cameron Kelly, DO
• Carl A Kelly IV, O.D.

• Dentist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.