Provider Demographics
NPI:1730299587
Name:BRANCH, JOERALD D (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOERALD
Middle Name:D
Last Name:BRANCH
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 1:493 N FRONT ST SUITE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-527-2101
Mailing Address - Fax:901-527-2103
Practice Address - Street 1:493 N FRONT ST SUITE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-527-2101
Practice Address - Fax:901-527-2103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS000052721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521203Medicaid