Provider Demographics
NPI:1003908948
Name:BRANNON, DAWN GILMORE (DDS)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:GILMORE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-5210
Mailing Address - Country:US
Mailing Address - Phone:910-997-6663
Mailing Address - Fax:910-997-6664
Practice Address - Street 1:120 MALLARD LN
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5210
Practice Address - Country:US
Practice Address - Phone:910-997-6663
Practice Address - Fax:910-997-6664
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991061Medicaid