Provider Demographics
NPI:1841385473
Name:BRATTON, BOBBY JOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:JOE
Last Name:BRATTON
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 1:9 N ATLANTA
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2901
Mailing Address - Country:US
Mailing Address - Phone:918-272-1256
Mailing Address - Fax:918-272-1255
Practice Address - Street 1:9 N ATLANTA
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2901
Practice Address - Country:US
Practice Address - Phone:918-272-1256
Practice Address - Fax:918-272-1255
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK835311OtherUNITED CONCORDIA