Provider Demographics
NPI:1013002682
Name:PATRICK J. BRANNON, D.M.D., PC
Entity Type:Organization
Organization Name:PATRICK J. BRANNON, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-859-0363
Mailing Address - Street 1:225 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-859-0363
Mailing Address - Fax:908-859-0651
Practice Address - Street 1:225 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865
Practice Address - Country:US
Practice Address - Phone:908-859-0363
Practice Address - Fax:908-859-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0182011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty