Provider Demographics
NPI:1447415138
Name:BRANDENBURG FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BRANDENBURG FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-422-4921
Mailing Address - Street 1:1120 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1514
Mailing Address - Country:US
Mailing Address - Phone:270-422-4921
Mailing Address - Fax:270-422-3550
Practice Address - Street 1:1120 HIGH ST
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1514
Practice Address - Country:US
Practice Address - Phone:270-422-4921
Practice Address - Fax:270-422-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty