Brandebura, John
Brandebura, John is an individual health care provider with primary practice located at 2407 S Waldron Rd , Fort Smith AR 72903-3736. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Brandebura, John can be contacted via phone (479) 484-1011.Contact Information
Primary practice address
2407 S Waldron Rd
Fort Smith AR 72903-3736
Phone: (479) 484-1011
Fax: (479) 484-1205
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 2226 | Arkansas |
Profile Details
| NPI number | 1629038708 |
|---|---|
| LBN Legal business name | Brandebura, John |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 24th, 2006 |
| Last updated | Apr 28th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629038708 | NPPES |
| Arkansas | MEDICAID | 127321679 | |
| Arkansas | Other | 5C081 | |
| Arkansas | MEDICAID | 100026580A | |
| Arkansas | Other | 000812852 | |
| Arkansas | Other | 1548288244 | |
| Arkansas | Other | 000861460 |
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