Provider Demographics
NPI:1477651594
Name:BRANNON, SIBERA TROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIBERA
Middle Name:TROY
Last Name:BRANNON
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 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:12005 N TATUM BLVD
Practice Address - Street 2:STE. 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1650
Practice Address - Country:US
Practice Address - Phone:602-971-0026
Practice Address - Fax:602-971-2069
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD68561223G0001X
MI29010164681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice