Provider Demographics
NPI:1043444144
Name:BRANNON, LAWRENCE SHERRILL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:SHERRILL
Last Name:BRANNON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 BERKMAR CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1406
Mailing Address - Country:US
Mailing Address - Phone:434-974-4555
Mailing Address - Fax:434-974-4558
Practice Address - Street 1:683 BERKMAR CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1406
Practice Address - Country:US
Practice Address - Phone:434-974-4555
Practice Address - Fax:434-974-4558
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist