Provider Demographics
NPI:1356557748
Name:BRATTON, MARY ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROSE
Last Name:BRATTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ROMS LN
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1738
Mailing Address - Country:US
Mailing Address - Phone:615-374-9456
Mailing Address - Fax:615-735-8023
Practice Address - Street 1:619 MAIN ST N STE A
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1259
Practice Address - Country:US
Practice Address - Phone:615-735-8066
Practice Address - Fax:615-735-8023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist