Provider Demographics
NPI:1548456924
Name:MARY J. BRANNOCK DDS PC
Entity type:Organization
Organization Name:MARY J. BRANNOCK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRANNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-922-0600
Mailing Address - Street 1:13430 N SCOTTSDALE RD
Mailing Address - Street 2:#100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4057
Mailing Address - Country:US
Mailing Address - Phone:480-922-0600
Mailing Address - Fax:480-922-0981
Practice Address - Street 1:13430 N SCOTTSDALE RD
Practice Address - Street 2:#100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4057
Practice Address - Country:US
Practice Address - Phone:480-922-0600
Practice Address - Fax:480-922-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4818261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1992874689OtherDENTAL