Provider Demographics
NPI:1689849465
Name:BRANNEN & YARBROUGH FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:BRANNEN & YARBROUGH FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-645-2749
Mailing Address - Street 1:1722 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4542
Mailing Address - Country:US
Mailing Address - Phone:931-645-2749
Mailing Address - Fax:931-645-2778
Practice Address - Street 1:1722 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4542
Practice Address - Country:US
Practice Address - Phone:931-645-2749
Practice Address - Fax:931-645-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS000068991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN014246OtherDORAL USA
TN803173OtherUNITED CONCORDIA