MEDICARE: NORMA BRANSON DDS, INC.

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	53897	CA

General Provider Information

NPI Number	:	1801349055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMA BRANSON DDS, INC.

Provider Business Mailing Address
First Line	:	5250 MURPHY CANYON RD STE 122
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4367
Country	:	US
Telephone Number	:	858-268-8112
Fax Number	:	858-268-4218

Provider Business Practice Location Address
First Line	:	5250 MURPHY CANYON RD STE 122
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4367
Country	:	US
Telephone Number	:	858-268-8112
Fax Number	:	858-268-4218

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. NORMA BRANSON
Credential	:	DDS
Telephone Number	:	858-268-8112

Provider Enumeration Date	:	07/24/2016
Last Update Date	:	12/13/2016

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