Provider Demographics
NPI:1184975757
Name:COLIN R. BRANTON,DMD
Entity type:Organization
Organization Name:COLIN R. BRANTON,DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BRANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-326-5456
Mailing Address - Street 1:2687 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-6754
Mailing Address - Country:US
Mailing Address - Phone:570-326-5456
Mailing Address - Fax:540-323-4550
Practice Address - Street 1:2687 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-6754
Practice Address - Country:US
Practice Address - Phone:570-326-5456
Practice Address - Fax:540-323-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030290L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty