Provider Demographics
NPI:1194853382
Name:BRATTON, JIMMIE WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:WAYNE
Last Name:BRATTON
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 1:910 OAK LN
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-2210
Mailing Address - Country:US
Mailing Address - Phone:940-937-2248
Mailing Address - Fax:940-937-8260
Practice Address - Street 1:910 OAK LN
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2210
Practice Address - Country:US
Practice Address - Phone:940-937-2248
Practice Address - Fax:940-937-8260
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice