Provider Demographics
NPI:1740775774
Name:BRANSON, JARROD PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:PHILLIP
Last Name:BRANSON
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 1:7768 OZARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5839
Mailing Address - Country:US
Mailing Address - Phone:904-442-6000
Mailing Address - Fax:904-503-1440
Practice Address - Street 1:7768 OZARK DR STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5839
Practice Address - Country:US
Practice Address - Phone:904-442-6000
Practice Address - Fax:904-503-1440
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN234331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice