Provider Demographics
NPI:1801145412
Name:BRANNON CROSSING FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:BRANNON CROSSING FAMILY DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-271-0083
Mailing Address - Street 1:231 E BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8059
Mailing Address - Country:US
Mailing Address - Phone:859-271-0083
Mailing Address - Fax:859-271-0156
Practice Address - Street 1:231 EAST BRANNON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-576-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty