Provider Demographics
NPI:1053381681
Name:BRAFFORD, MARY ANGELA (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANGELA
Last Name:BRAFFORD
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANGELA
Other - Last Name:DIETRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:94 FACTORY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1487
Mailing Address - Country:US
Mailing Address - Phone:240-277-9772
Mailing Address - Fax:
Practice Address - Street 1:1 PINCKNEY BLVD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6122
Practice Address - Country:US
Practice Address - Phone:240-277-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0250501223P0700X
VA04014118711223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics