Provider Demographics
NPI:1386848018
Name:BRANCOLINI, AMBER (DMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BRANCOLINI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ELM DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8269
Mailing Address - Country:US
Mailing Address - Phone:724-852-2336
Mailing Address - Fax:
Practice Address - Street 1:232 ELM DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8269
Practice Address - Country:US
Practice Address - Phone:724-852-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice