KELLY BRASWELL DDS LLC (NPI# 1700091600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700091600 |
| Entity Type | Organization |
| Organization Name | KELLY BRASWELL DDS LLC |
| Other Organization Name | KELLY BRASWELL DDS |
| Practice Address |
3718 Jewella Shreveport LA 71109-4704 |
| Mailing Address |
3718 Jewella Ave Shreveport LA 71109-4704 |
| Practice Telephone | 3186366923 |
| Mailing Telephone | 3186366923 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. KELLY W BRASWELL (OWNER DENTIST) |
| Authorized Official Telephone | 3186366923 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | LA4050 | LA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1840505 | 05 |
| Other Name | Type Code |
|---|---|
| Kelly Braswell DDS | Former Legal Business Name - Organization |
| Street Address |
3718 JEWELLA |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71109-4704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548784416 | Barbara Smith | Counselor | 4019 Greenwood Road, Shreveport, LA 71109 | 2017-08-01 |
| 1508306135 | Cherise Sims | Case Manager/Care Coordinator | 3512 Greenbriar Dr, Shreveport, LA 71109 | 2017-03-01 |
| 1174063093 | Nitika Pinesett | Case Manager/Care Coordinator | 3011 Independence Ave, Shreveport, LA 71109 | 2017-02-24 |
| 1831640986 | Aleric Hamilton | Counselor | 2605 Leaf Ln, Shreveport, LA 71109 | 2016-10-24 |
| 1144673963 | Lakeishia Johnson | Technician | 5342 Broadway Ave, Shreveport, LA 71109 | 2016-07-16 |
| 1083074223 | Patricia Pouncy | Counselor | 4019 Greenwood Rd, Shreveport, LA 71109 | 2016-03-01 |
| 1326418518 | Deepasulochana Sivasankaraganesan | Dentist | 3719 Jewella Ave, Shreveport, LA 71109 | 2015-09-30 |
| 1063611838 | Della Edwards Wills | Social Worker | 4615 Monkhouse Drive, Ste A-2-b, Shreveport, LA 71109 | 2007-07-12 |
| 1083743041 | An Endless Love Home Care, LLC | Point of Service | 6259 Tinker Street, Shreveport, LA 71109 | 2007-03-05 |
| 1316009624 | Djenane Rousseau | Pharmacist | 4140 Hollywood, Shreveport, LA 71109 | 2006-12-14 |
| Find all providers in zip 71109 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194385203 | Carlee Gilley | Dentist | 8691 Line Ave, Shreveport, LA 71106-6148 | 2019-06-20 |
| 1780247197 | Patricia Ann Hostyn | Dentist | 7344 Capistrano Dr, Shreveport, LA 71105-5036 | 2019-04-22 |
| 1326418518 | Deepasulochana Sivasankaraganesan | Dentist | 3719 Jewella Ave, Shreveport, LA 71109 | 2015-09-30 |
| 1891173449 | Miles for Smiles, LLC | Dentist | 610 Texas St, Shreveport, LA 71101-3554 | 2015-05-15 |
| 1902299233 | Brady H. Mosher | Dentist | 7251 Youree Dr, Shreveport, LA 71105 | 2015-03-11 |
| 1952710188 | Clayte Austin Fluke | Dentist | 1105 Island Park Blvd Apt 820, Shreveport, LA 71105-4772 | 2014-08-13 |
| 1467634451 | William L Mccolgan Jr. | Dentist | 9125 Mansfield Road, Shreveport, LA 71118 | 2007-11-30 |
| 1730372590 | Carole Suzanne Windham | Dentist | 6140 Line Ave, Shreveport, LA 71106-2051 | 2007-08-23 |
| 1316158207 | Charles R Mcinnis | Dentist | 8938 Kingston Road, Shreveport, LA 71118 | 2007-05-24 |
| 1346458304 | Lester Ewing | Dentist | 923 Shreveport Barksdale Hwy, Shreveport, LA 71105-2205 | 2007-05-21 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.