Individual
DR. DANA MICHELLE BROTHERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.,M.D.
Contact information
Practice address
11970 WILCREST DR, SUITE 101, HOUSTON, TX 77031-1923
(281) 933-9950
(281) 933-9953
Mailing address
11970 WILCREST DR, SUITE 101, HOUSTON, TX 77031-1923
(281) 933-9950
(281) 933-9953
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17060
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7453145
AETNA PROVIDER #
TX
01
—
8B9090
BC/BS PROVIDER #
TX
Enumeration date
10/20/2006
Last updated
07/09/2007
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