Provider Demographics
NPI:1922414432
Name:BRANSON, DANIEL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
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 1:702 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-1939
Mailing Address - Country:US
Mailing Address - Phone:641-430-1348
Mailing Address - Fax:
Practice Address - Street 1:702 23RD ST
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-1939
Practice Address - Country:US
Practice Address - Phone:641-430-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-090971223G0001X
WI1001665-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice