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General NPI Number Information
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NPI Number | 1326597238
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Entity Type | Individual
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Provider Name | NICOLAS ROBERT BRANSHAW DMD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 17135 W. CAPITOL DR. SUITE 100
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City | BROOKFIELD
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State | WI
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Zip | 53005-2193
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Country | US
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Telephone | 262-200-9445
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Fax |
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Provider Business Mailing Address
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Address Line | 7117 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-1450
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Country | US
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Telephone | 715-828-9655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1001398
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1001398
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License Number State | WI
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