Provider Demographics
NPI:1245220474
Name:BRABSON, ANITA LYNNETTE (DDS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LYNNETTE
Last Name:BRABSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 CLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5302
Mailing Address - Country:US
Mailing Address - Phone:757-673-7548
Mailing Address - Fax:
Practice Address - Street 1:3620 COUNTY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3104
Practice Address - Country:US
Practice Address - Phone:757-397-8877
Practice Address - Fax:757-397-8997
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice