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Individual

DR. JOHN DAVID BRANNEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
111 LAKEWOOD DR, SUITE A, LULING, LA 70070-3002
(985) 785-6838
Mailing address
111 LAKEWOOD DR, SUITE A, LULING, LA 70070-3002
(985) 785-6838

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3931
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1839311
LA
01
4017984TN
BC-BS OF TN
TN
01
A1998LA
BC-BS OF LA
LA
Enumeration date
03/03/2007
Last updated
07/08/2007
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