Provider Demographics
NPI:1407929748
Name:BARTON, BRANDON H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:H
Last Name:BARTON
Suffix:JR
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 1:11200 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3929
Mailing Address - Country:US
Mailing Address - Phone:313-521-6400
Mailing Address - Fax:313-521-4710
Practice Address - Street 1:11200 E MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3929
Practice Address - Country:US
Practice Address - Phone:313-521-6400
Practice Address - Fax:313-521-4710
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI126311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382492460OtherTIN