Provider Demographics
NPI:1619180239
Name:BRANTON, COLIN R (DMD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:R
Last Name:BRANTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-6754
Mailing Address - Country:US
Mailing Address - Phone:570-326-5456
Mailing Address - Fax:570-323-4550
Practice Address - Street 1:2687 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-6754
Practice Address - Country:US
Practice Address - Phone:570-326-5456
Practice Address - Fax:570-323-4550
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030290L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice