MEDICARE: DR. STEPHEN RICHARD BRANAM D.D.S.

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	1223P0221X	Pediatric Dentistry	14897	OH

General Provider Information

NPI Number	:	1770560492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN RICHARD BRANAM D.D.S.

Provider Business Mailing Address
First Line	:	3140 DUSTIN RD
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-4341
Country	:	US
Telephone Number	:	419-698-4339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 DUSTIN RD
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-4341
Country	:	US
Telephone Number	:	419-698-4339
Fax Number	:	419-698-3484

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/09/2013

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