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General NPI Number Information
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NPI Number | 1518187251
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Entity Type | Individual
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Provider Name | SHELLIE ANN BRANSON DMD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 2015 HERR LANE SUITE D
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City | LOUISVILLE
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State | KY
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Zip | 40222
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Country | US
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Telephone | 502-426-0088
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Fax | 502-426-7828
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Provider Business Mailing Address
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Address Line | 2015 HERR LANE SUITE D
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City | LOUISVILLE
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State | KY
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Zip | 40222
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Country | US
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Telephone | 502-426-0088
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Fax | 502-426-7828
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5779
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License Number State | KY
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