Provider Demographics
NPI:1528611381
Name:REBEKAH W. BRANSCUM, DMD, PSC
Entity type:Organization
Organization Name:REBEKAH W. BRANSCUM, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-636-3431
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-0906
Mailing Address - Country:US
Mailing Address - Phone:606-636-4311
Mailing Address - Fax:606-636-4315
Practice Address - Street 1:8536 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-7744
Practice Address - Country:US
Practice Address - Phone:606-636-4311
Practice Address - Fax:606-636-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002979Medicaid
KY7100606180Medicaid