Provider Demographics
NPI:1174373633
Name:BRIAN F. BRAGASSA DMD, LLC
Entity type:Organization
Organization Name:BRIAN F. BRAGASSA DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-862-4570
Mailing Address - Street 1:300 PRIME PT STE 200
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6851
Mailing Address - Country:US
Mailing Address - Phone:770-487-5505
Mailing Address - Fax:
Practice Address - Street 1:300 PRIME PT STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6851
Practice Address - Country:US
Practice Address - Phone:770-487-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty