Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401414243 | VA |
NPI | 1033431770 |
---|---|
Provider Name | Dr. Darchelle Marie Braxton |
First Address | Hampton, VA 23666 |
Second Address | Hampton, VA 23666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2010 |
Last Update Date | 24/09/2014 |