MEDICARE: PAUL ALAN BRANNEN DMD

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	122300000X	Dentist	D9660	OR
2	1223G0001X	General Practice Dentistry	D9960	OR
3	122300000X	Dentist	DEN D 1310	AK

General Provider Information

NPI Number	:	1881825032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ALAN BRANNEN DMD

Provider Business Mailing Address
First Line	:	4372 LIBERTY RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-6171
Country	:	US
Telephone Number	:	503-581-3727
Fax Number	:	503-339-9568

Provider Business Practice Location Address
First Line	:	4372 LIBERTY RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-6171
Country	:	US
Telephone Number	:	503-581-3727
Fax Number	:	503-339-9568

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

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	07/31/2024

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