Provider Demographics
NPI:1770560492
Name:BRANAM, STEPHEN RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:BRANAM
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 1:3140 DUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4341
Mailing Address - Country:US
Mailing Address - Phone:419-698-4339
Mailing Address - Fax:
Practice Address - Street 1:3140 DUSTIN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4341
Practice Address - Country:US
Practice Address - Phone:419-698-4339
Practice Address - Fax:419-698-3484
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry