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General NPI Number Information
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NPI Number | 1568766624
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Entity Type | Individual
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Provider Name | BRANDON CHARLES SHAMBLIN DDS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 2810 OAK RUN PKWY SUITE 300
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City | NEW BRAUNFELS
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State | TX
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Zip | 78132-4757
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Country | US
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Telephone | 214-662-9256
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 OAK RUN PKWY SUITE 300
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City | NEW BRAUNFELS
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State | TX
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Zip | 78132-4757
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Country | US
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Telephone | 830-515-5365
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Fax | 830-893-0111
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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 | 0026091
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0026091
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License Number State | TX
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