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General NPI Number Information
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NPI Number | 1669170825
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Entity Type | Organization
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Legal Business Name | REBEKAH BRANSCUM DRE LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 8536 W HIGHWAY 80
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City | NANCY
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State | KY
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Zip | 42544-7744
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Country | US
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Telephone | 606-636-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 8536 W HIGHWAY 80
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City | NANCY
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State | KY
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Zip | 42544-7744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GREG WHITE
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Credential |
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Telephone | 859-533-1109
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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 |
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License Number State |
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