Provider Demographics
NPI:1184686842
Name:BRANNON & BRANNON A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRANNON & BRANNON A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-485-6600
Mailing Address - Street 1:15525 POMERADO ROAD
Mailing Address - Street 2:SUITE C6
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2426
Mailing Address - Country:US
Mailing Address - Phone:858-485-6600
Mailing Address - Fax:858-673-5546
Practice Address - Street 1:15525 POMERADO ROAD
Practice Address - Street 2:SUITE C6
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2426
Practice Address - Country:US
Practice Address - Phone:858-485-6600
Practice Address - Fax:858-673-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty