Provider Demographics
NPI:1184744393
Name:BRAKEBILL, WILLIAM PAUL JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:BRAKEBILL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 LAKESIDE RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-6231
Mailing Address - Country:US
Mailing Address - Phone:865-458-4479
Mailing Address - Fax:423-442-4290
Practice Address - Street 1:966 LAKESIDE RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-6231
Practice Address - Country:US
Practice Address - Phone:865-458-4479
Practice Address - Fax:423-442-4290
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist