MEDICARE: DR. JAMES EDWARDS BRANNEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		TN

General Provider Information

NPI Number	:	1023170024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARDS BRANNEN DDS

Provider Business Mailing Address
First Line	:	1722 MEMORIAL DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4542
Country	:	US
Telephone Number	:	931-645-2749
Fax Number	:	931-645-2778

Provider Business Practice Location Address
First Line	:	1722 MEMORIAL DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4542
Country	:	US
Telephone Number	:	931-645-2749
Fax Number	:	931-645-2778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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