Provider Demographics
NPI:1518187251
Name:BRANSON, SHELLIE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLIE
Middle Name:ANN
Last Name:BRANSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 HERR LANE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-426-0088
Mailing Address - Fax:502-426-7828
Practice Address - Street 1:2015 HERR LANE
Practice Address - Street 2:SUITE D
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-426-0088
Practice Address - Fax:502-426-7828
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry