Provider Demographics
NPI:1568766624
Name:SHAMBLIN, BRANDON CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CHARLES
Last Name:SHAMBLIN
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 1:2810 OAK RUN PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4757
Mailing Address - Country:US
Mailing Address - Phone:830-515-5365
Mailing Address - Fax:830-893-0111
Practice Address - Street 1:2810 OAK RUN PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4757
Practice Address - Country:US
Practice Address - Phone:214-662-9256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0026091122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist