Provider Demographics
NPI:1417115288
Name:BRANSCOME, THOMAS ARMSTEAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARMSTEAD
Last Name:BRANSCOME
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 EAST FIFTH STREET
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674
Mailing Address - Country:US
Mailing Address - Phone:256-383-2031
Mailing Address - Fax:256-383-9039
Practice Address - Street 1:208 EAST FIFTH STREET
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674
Practice Address - Country:US
Practice Address - Phone:256-383-2031
Practice Address - Fax:256-383-9039
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
90137OtherBLUE CROSS BLUE SHIELD