Provider Demographics
NPI:1871887521
Name:BRANNON, JOSEPH JR (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BRANNON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9630 MILESTONE WAY APT 1067
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4370
Mailing Address - Country:US
Mailing Address - Phone:803-378-6758
Mailing Address - Fax:
Practice Address - Street 1:9199 REISTERSTOWN RD STE 203A
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4514
Practice Address - Country:US
Practice Address - Phone:410-356-8571
Practice Address - Fax:410-356-8574
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist