Provider Demographics
NPI:1932078540
Name:BRANTLEY, TUESDAY (RDH)
Entity type:Individual
Prefix:
First Name:TUESDAY
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:LA COSTE
Mailing Address - State:TX
Mailing Address - Zip Code:78039-0202
Mailing Address - Country:US
Mailing Address - Phone:832-563-2155
Mailing Address - Fax:
Practice Address - Street 1:15068 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3714
Practice Address - Country:US
Practice Address - Phone:210-494-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27380124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty