Provider Demographics
NPI:1881825032
Name:BRANNEN, PAUL ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:BRANNEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6171
Mailing Address - Country:US
Mailing Address - Phone:971-801-3394
Mailing Address - Fax:503-339-9568
Practice Address - Street 1:4372 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6171
Practice Address - Country:US
Practice Address - Phone:971-801-3394
Practice Address - Fax:503-339-9568
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDEN D 1310122300000X
ORD9660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist