Provider Demographics
NPI:1659482024
Name:BRAME, PHILLIP MARVIN SR (DDS MS BOARD CERTIFI)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MARVIN
Last Name:BRAME
Suffix:SR
Gender:M
Credentials:DDS MS BOARD CERTIFI
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:MARVIN
Other - Last Name:BRAME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS PA
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:1419 WEST D ST
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1367
Mailing Address - Country:US
Mailing Address - Phone:336-667-1254
Mailing Address - Fax:336-667-1255
Practice Address - Street 1:1419 WEST D ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-1367
Practice Address - Country:US
Practice Address - Phone:336-667-1254
Practice Address - Fax:336-667-1255
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991034Medicaid