Provider Demographics
NPI:1790989176
Name:BRANCHAUD, JAMES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:BRANCHAUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 DUPONT CT
Mailing Address - Street 2:STE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2153
Mailing Address - Country:US
Mailing Address - Phone:402-330-2330
Mailing Address - Fax:402-330-6079
Practice Address - Street 1:14441 DUPONT CT
Practice Address - Street 2:STE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2153
Practice Address - Country:US
Practice Address - Phone:402-330-2330
Practice Address - Fax:402-330-6079
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025190900Medicaid