Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 019-025050 | IL |
Y | 1223P0700X | Prosthodontist | 0401411871 | VA |
NPI | 1053381681 |
---|---|
Provider Name | Dr. Mary Angela Brafford |
First Address | Beaufort, SC 29907-1487 |
Second Address | Beaufort, SC 29902-6122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 01/06/2010 |