Provider Demographics
NPI:1922749688
Name:BRANTLEY, THOMAS HUNTER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HUNTER
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CHANCELLORSVILLE DR APT 333
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4818
Mailing Address - Country:US
Mailing Address - Phone:850-524-3603
Mailing Address - Fax:
Practice Address - Street 1:2929B CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4407
Practice Address - Country:US
Practice Address - Phone:850-656-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL272281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program