Provider Demographics
NPI:1750376224
Name:BRANCATO, MARIE-ANTONETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIE-ANTONETTE
Middle Name:
Last Name:BRANCATO
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 1:15TH MDG
Mailing Address - Street 2:755 SCOTT CIRCLE
Mailing Address - City:JBPH-HICKAM
Mailing Address - State:HI
Mailing Address - Zip Code:96853
Mailing Address - Country:US
Mailing Address - Phone:808-448-6371
Mailing Address - Fax:
Practice Address - Street 1:15TH MDG
Practice Address - Street 2:755 SCOTT CIRCLE
Practice Address - City:JBPH-HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:808-448-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI01898300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist