Provider Demographics
NPI:1629525381
Name:BRANTLEY, DOLPHUS III
Entity Type:Individual
Prefix:
First Name:DOLPHUS
Middle Name:
Last Name:BRANTLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5783
Mailing Address - Country:US
Mailing Address - Phone:252-830-0400
Mailing Address - Fax:
Practice Address - Street 1:2501 COTTONTAIL LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5125
Practice Address - Country:US
Practice Address - Phone:732-529-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1486237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist