Provider Demographics
NPI:1669493276
Name:BRANTLEY, DAVID H (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:BRANTLEY
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 1:495 FURYS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8221
Mailing Address - Country:US
Mailing Address - Phone:706-863-7351
Mailing Address - Fax:706-863-2585
Practice Address - Street 1:495 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8221
Practice Address - Country:US
Practice Address - Phone:706-863-7351
Practice Address - Fax:706-863-2585
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0096221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000279188BMedicaid
GA9180554OtherDORAL
GA000279188AMedicaid