MEDICARE: BRANHAM DENTAL LLC

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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1922767276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANHAM DENTAL LLC

Provider Business Mailing Address
First Line	:	4610 MEADOWS LN STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2965
Country	:	US
Telephone Number	:	702-878-7700
Fax Number	:	702-878-4630

Provider Business Practice Location Address
First Line	:	4610 MEADOWS LN STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2965
Country	:	US
Telephone Number	:	702-878-7700
Fax Number	:	702-878-4630

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE BRANHAM
Credential	:
Telephone Number	:	702-878-7700

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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Directions to “BRANHAM DENTAL LLC ” Practice Location

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