MEDICARE: DR. DALE JOSEPH BRANT 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	122300000X	Dentist	15696	TX

General Provider Information

NPI Number	:	1396824389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE JOSEPH BRANT DDS

Provider Business Mailing Address
First Line	:	6560 FANNIN
Second Line	:	SUITE 1424
City	:	HOUSTON
State	:	TX
Zip	:	77030-2713
Country	:	US
Telephone Number	:	713-795-5905
Fax Number	:	713-795-0806

Provider Business Practice Location Address
First Line	:	6560 FANNIN
Second Line	:	SUITE 1424
City	:	HOUSTON
State	:	TX
Zip	:	77030-2713
Country	:	US
Telephone Number	:	713-795-5905
Fax Number	:	713-795-0806

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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