Healthcare Provider Details

I. General information

NPI: 1962681122
Provider Name (Legal Business Name): WILLIAM ROBERT BRATTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5040
  • Fax: 707-825-6747
Mailing address:
  • Phone: 530-284-6135
  • Fax: 530-284-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: