MEDICARE: DR. RICHARD WESLEY BRANSFORD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0026499	TX

General Provider Information

NPI Number	:	1467740464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WESLEY BRANSFORD D.D.S.

Provider Business Mailing Address
First Line	:	3110 TRAWOOD DR STE D
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3842
Country	:	US
Telephone Number	:	915-855-1000
Fax Number	:	915-855-6600

Provider Business Practice Location Address
First Line	:	3110 TRAWOOD DR STE D
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3842
Country	:	US
Telephone Number	:	915-855-1000
Fax Number	:	915-855-6600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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