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General NPI Number Information
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NPI Number | 1972137479
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Entity Type | Individual
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Provider Name | NICHOLAS BRANHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ STE 230
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-361-6006
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD STE 1010
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1210
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Country | US
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Telephone | 314-721-1010
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Fax | 314-721-5276
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2024009328
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License Number State | MO
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