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General NPI Number Information
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NPI Number | 1467991133
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Entity Type | Individual
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Provider Name | KHALEILA BRANNON DDS
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Gender | Female
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 1500 PARKLAWN DR UNIT 814
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City | CHARLESTON
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State | SC
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Zip | 29414-8137
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Country | US
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Telephone | 410-123-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 PARKLAWN DR UNIT 814
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City | CHARLESTON
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State | SC
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Zip | 29414-8137
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Country | US
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Telephone | 443-123-2345
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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 | 15994
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License Number State | MD
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