Organization Name: | BIVONA AND BRANSTETTER FAMILY DENTAL, LLC |
NPI Number: | 1003272907 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN BRANSTETTER (PARTNER) |
Mailing Address: | 1208 Highway 78 E Jasper |
State: | AL US |
Postal Code: | 355013963 |
Phone Number: | 2052212733 |
Fax Number: | |
NPI Enumeration Date: | 01/07/2016 |
NPI Last Update Date: | 01/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 4217 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |