Provider Demographics
NPI:1114112703
Name:BRANTLY, PHILIP K (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:K
Last Name:BRANTLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PARKWAY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-3477
Mailing Address - Country:US
Mailing Address - Phone:919-751-0711
Mailing Address - Fax:919-751-1248
Practice Address - Street 1:1100 PARKWAY DR
Practice Address - Street 2:SUITE A
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-3477
Practice Address - Country:US
Practice Address - Phone:919-751-0711
Practice Address - Fax:919-751-1248
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice