Provider Demographics
NPI:1922767276
Name:BRANHAM DENTAL LLC
Entity Type:Organization
Organization Name:BRANHAM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-878-7700
Mailing Address - Street 1:4610 MEADOWS LN STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2965
Mailing Address - Country:US
Mailing Address - Phone:702-878-7700
Mailing Address - Fax:702-878-4630
Practice Address - Street 1:4610 MEADOWS LN STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2965
Practice Address - Country:US
Practice Address - Phone:702-878-7700
Practice Address - Fax:702-878-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty