Individual
REGINA JANET BRANNON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
350 HOSPITAL DR, SPENCER, WV 25276-1049
(304) 927-2775
(304) 927-2777
Mailing address
350 HOSPITAL DR, SPENCER, WV 25276-1049
(304) 927-2775
(304) 927-2777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV2709
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00815631
BLUE CROSS
WV
05
—
0316928000
—
WV
01
—
1535747
UNITED CONCORDIA
WV
Enumeration date
04/19/2006
Last updated
07/08/2007
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