Provider Demographics
NPI:1437317757
Name:BRANNEN, JOSEPH OLEM (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:OLEM
Last Name:BRANNEN
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 1:4394 HUGH HOWELL RD SUITE 7
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4913
Mailing Address - Country:US
Mailing Address - Phone:770-621-0830
Mailing Address - Fax:770-621-9893
Practice Address - Street 1:4394 HUGH HOWELL RD SUITE 7
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4913
Practice Address - Country:US
Practice Address - Phone:770-621-0830
Practice Address - Fax:770-621-9893
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist