MEDICARE: WARREN B. BRANCH DDS PLLC

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	12797	TX

General Provider Information

NPI Number	:	1245710151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN B. BRANCH DDS PLLC

Provider Business Mailing Address
First Line	:	3301 OAKWELL CT STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3074
Country	:	US
Telephone Number	:	210-653-8398
Fax Number	:	210-653-9533

Provider Business Practice Location Address
First Line	:	3301 OAKWELL CT STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3074
Country	:	US
Telephone Number	:	210-653-8398
Fax Number	:	210-653-9533

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. WARREN BOOWELL BRANCH
Credential	:
Telephone Number	:	210-653-8398

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/21/2018

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