Provider Demographics
NPI:1205993722
Name:BRATTON, TERRANCE ALFONSO (DDS)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:ALFONSO
Last Name:BRATTON
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 1:8052 MALL PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2649
Mailing Address - Country:US
Mailing Address - Phone:770-484-0135
Mailing Address - Fax:615-327-0730
Practice Address - Street 1:8052 MALL PKWY STE 205
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038
Practice Address - Country:US
Practice Address - Phone:770-484-0135
Practice Address - Fax:615-327-0730
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS79441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV00191Medicare UPIN
TN3227512Medicare ID - Type Unspecified