Provider Demographics
NPI:1508546037
Name:BRANDON M. SNELL OROFACIAL PAIN CLINIC, LLC
Entity Type:Organization
Organization Name:BRANDON M. SNELL OROFACIAL PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-347-0036
Mailing Address - Street 1:907 RUCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2124
Mailing Address - Country:US
Mailing Address - Phone:334-347-0036
Mailing Address - Fax:
Practice Address - Street 1:907 RUCKER BLVD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2124
Practice Address - Country:US
Practice Address - Phone:334-347-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty