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General NPI Number Information
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NPI Number | 1184686842
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Entity Type | Organization
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Legal Business Name | BRANNON & BRANNON A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15525 POMERADO ROAD SUITE C6
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City | POWAY
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State | CA
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Zip | 92064-2426
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Country | US
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Telephone | 858-485-6600
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Fax | 858-673-5546
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Provider Business Mailing Address
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Address Line | 15525 POMERADO ROAD SUITE C6
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City | POWAY
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State | CA
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Zip | 92064-2426
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Country | US
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Telephone | 858-485-6600
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Fax | 858-673-5546
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Authorized Official
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Title or Position | PRESIDENT
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Name | WAYNE ALAN BRANNON
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Credential | DDS
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Telephone | 858-485-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22048
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License Number State | CA
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