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General NPI Number Information
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NPI Number | 1548456924
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Entity Type | Organization
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Legal Business Name | MARY J. BRANNOCK DDS PC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 13430 N SCOTTSDALE RD #100
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4057
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Country | US
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Telephone | 480-922-0600
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Fax | 480-922-0981
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Provider Business Mailing Address
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Address Line | 13430 N SCOTTSDALE RD #100
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4057
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Country | US
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Telephone | 480-922-0600
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Fax | 480-922-0981
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Authorized Official
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Title or Position | OFICE MANAGER
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Name | DAVID W BRANNOCK
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Credential |
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Telephone | 480-922-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4818
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License Number State | AZ
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